CVD: Primary Care Intelligence Packs NHS Lambeth CCG

June 2017 Version 1 Contents

1. Introduction 3

2. CVD prevention • The narrative 11 • The data 13 3. Hypertension • The narrative 16 • The data 17 4. Stroke • The narrative 27 • The data 28 5. Diabetes • The narrative 42 • The data 43 6. Kidney • The narrative 53 • The data 54 7. Heart • The narrative 65 • The data 66 8. Outcomes 82

9. Appendix 88 This document is valid only when viewed via the internet. If it is printed into hard copy or saved to another location, you must first check that the version number on your copy matches that of the one online. Printed copies are uncontrolled copies.

2 CVD: Primary Care Intelligence Packs Introduction

3 CVD: Primary Care Intelligence Packs This intelligence pack has been compiled by GPs and nurses and pharmacists in the Primary Care CVD Leadership Forum in collaboration with the National Cardiovascular Intelligence Network

Matt Kearney Sarit Ghosh Kathryn Griffith George Kassianos Jo Whitmore Matthew Fay Chris Harris Jan Procter-King Yassir Javaid Ivan Benett Ruth Chambers Ahmet Fuat Mike Kirby Peter Green Kamlesh Khunti Helen Williams Quincy Chuhka Sheila McCorkindale Nigel Rowell Ali Morgan Stephen Kirk Sally Christie Clare Hawley Paul Wright Bruce Taylor Mike Knapton John Robson Richard Mendelsohn Chris Arden David Fitzmaurice

4 CVD: Primary Care Intelligence Packs Local intelligence as a tool for clinicians and commissioners to improve outcomes for our patients Why should we use this CVD Intelligence Pack The high risk conditions for cardiovascular disease (CVD) - such as hypertension, atrial fibrillation, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease - are the low hanging fruit for prevention in the NHS because in each case late diagnosis and suboptimal treatment is common and there is substantial variation. High quality primary care is central to improving outcomes in CVD because primary care is where much prevention and most diagnosis and treatment is delivered. This cardiovascular intelligence pack is a powerful resource for stimulating local conversations about quality improvement in primary care. Across a number of vascular conditions, looking at prevention, diagnosis, care and outcomes, the data allows comparison between clinical commissioning groups (CCGs) and between practices. This is not about performance management because we know that variation can have more than one interpretation. But patients have a right to expect that we will ask challenging questions about how the best practices are achieving the best, what average or below average performers could do differently, and how they could be supported to perform as well as the best.

How to use the CVD intelligence pack The intelligence pack has several sections – CVD prevention, hypertension, stroke and atrial fibrillation (AF), diabetes, kidney disease, heart disease and heart failure. Each section has one slide of narrative that makes the case and asks some questions. This is followed by data for a number of indicators, each with benchmarked comparison between CCGs and between practices. Use the pack to identify where there is variation that needs exploring and to start asking challenging questions about where and how quality could be improved. We suggest you then develop a local action plan for quality improvement – this might include establishing communities of practice to build clinical leadership, systematic local audit to get a better understanding of the gaps in care and outcomes, and developing new models of care that mobilise the wider primary care team to reduce burden on general practice.

5 CVD: Primary Care Intelligence Packs Data and methods

This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic transformation plan (STP) and England. Where a CCG is in more than one STP, it has been allocated to the STP with the greatest geographical or population coverage. The slide pack also compares the CCG to its 10 most similar CCGs in terms of demography, ethnicity and deprivation. For information on the methodology used to calculate the 10 most similar CCGs please go to: http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/

The 10 most similar CCGs to NHS Lambeth CCG are: NHS Southwark CCG NHS City and Hackney CCG NHS Lewisham CCG NHS Hammersmith and Fulham CCG NHS Waltham Forest CCG NHS Wandsworth CCG NHS Brent CCG NHS Haringey CCG NHS Greenwich CCG NHS Newham CCG

The majority of data used in the packs is taken from the 2015/16 Quality and Outcomes Framework (QOF). Where this is not the case, this is indicated in the slide. All GP practices that were included in the 2015/16 QOF are included. Full source data are shown in the appendix.

For the majority of indicators, the additional number of people that would be treated if all practices were to achieve as well as the average of the top achieving practices is calculated. This is calculated by taking an average of the intervention rates (ie the denominator includes exceptions) for the best 50% of practices in the CCG and applying this rate to all practices in the CCG. Note, this number is not intended to be proof of a realisable improvement; rather it gives an indication of the magnitude of available opportunity.

6 CVD: Primary Care Intelligence Packs Why does variation matter?

A key observation about benchmarking data is The variation that exists between that it does not tell us why there is variation. Some of the demographically similar CCGs and variation may be explained by population or case mix and some may be unwarranted. We will not know unless we between practices illustrates the local investigate. potential to improve care and outcomes for our patients Benchmarking may not be conclusive. Its strength lies not in the answers it provides but in the questions it generates for CCGs and practices. Benchmarking is helpful because it highlights variation. For example: 1. How much variation is there in detection, management, Of course it has long been acknowledged that some exception reporting and outcomes? variation is inevitable in the healthcare and outcomes 2. How many people would benefit if average performers experienced by patients. improved to the level of the best performers? But John Wennberg, who has championed research 3. How many people would benefit if the lowest performers into clinical variation over four decades and who matched the achievement of the average? founded the pioneering Dartmouth Atlas of Health 4. What are better performers doing differently in the way Care, concluded that much variation is unwarranted – they provide services in order to achieve better outcomes? ie it cannot be explained on the basis of illness, 5. How can the CCG support low and average performers to medical evidence, or patient preference, but is help them match the achievement of the best? accounted for by the willingness and ability of doctors 6. How can we build clinical leadership to drive quality to offer treatment. improvement?

There are legitimate reasons for exception reporting. But ……. Excepting patients from indicators puts them at risk of not receiving optimal care and of having worse outcomes. It is also likely to increase health inequalities. The substantial variation seen in exception reporting for some indicators suggests that some practices are more effective than others at reaching their whole population. Benchmarking exception reporting 7 allows us to identify the practices that need support to implement the strategies adopted by low excepting practices. Cluster methodology: your most similar practices

Each practice has been grouped on the basis of demographic data into 15 national clusters. These demographic factors cover: • deprivation (practice level) • age profile (% < 5, % < 18, % 15-24, % 65+, % 75+, % 85+) • ethnicity (% population of white ethnicity) • practice population side

These demographic factors closely align with those used to calculate the “Similar 10 CCGs”. These demographic factors have been used to compare practices with similar populations to account for potential factors which may drive variation. Some local interpretation will need to be applied to the data contained within the packs as practices with significant outlying population characteristics e.g. university populations or care home practices will need further contextualisation. Further detailed information including full technical methodology and a full PDF report on each of the 15 practice clusters is available here: https://github.com/julianflowers/geopractice.

8 CVD: Primary Care Intelligence Packs Cluster methodology: calculating potential gains

The performance of every practice in the GP cluster contributes to the average of the top performing 50% of practices to form a benchmark.

5% 0% -5% -10% -15% -20%

WELLINGTON ROAD SURGERY 7

EMERSONS GREEN MEDICAL CENTRE 9

LEAP VALLEY MEDICAL CENTRE 22

CHRISTCHURCH FAMILY MEDICAL CENTRE 21

CONISTON MEDICAL PRACTICE 17

FROME VALLEY MEDICAL CENTRE 31

ST MARY STREET SURGERY 14 KINGSWOODRaw HEALTH difference CENTRE between the Potential opportunity if 15 Potential opportunity if the CONCORDpractice MEDICAL CENTRE value the practice value was 12 CCG value were to move KENNEDYand WAY the SURGERY average of the to move to the average 9 to the average of the top 5 highest or lowest 50% of of the highest 50% of performing closest CCGs similar cluster practices similar cluster practices BRADLEY STOKE SURGERY 3

THE WILLOW SURGERY 5

CLOSE FARM SURGERY 1 The difference between the benchmark and the selected practices is displayed on this chart. The benchmark will most likelyPILNING be SURGERY different for different practices as they are in different clusters, so1 the difference is the key measure here. IfCOURTSIDE the practice SURGERY performance is below the benchmark, the difference is applied1 to the denominator plus exceptionsALMONDSBURY to SURGERY demonstrate potential gains on a practice basis. The potential gains on a CCG basis are calculated

STOKEbased GIFFORD on MEDICAL the CENTREdifference between the top 5 performing closest CCGs and the selected CCG, applied to the

denominatorORCHARD MEDICAL plus CENTRE exceptions.

WEST WALK SURGERY

THORNBURY9 CVD: HEALTH PrimaryCENTRE - BURNEY Care Intelligence Packs CVD prevention

10 CVD: Primary Care Intelligence Packs CVD prevention

The size of the prevention problem “The NHS needs a radical upgrade • 2/3 of adults are obese or overweight in prevention if it is to be • 1/3 of adults are physically inactive sustainable” • average smoking prevalence is 17% but is much 5 year Forward View 2014 higher in some communities • in high risk conditions like atrial fibrillation, high blood pressure, diabetes and high ten year CVD risk score, This is because England faces an epidemic of largely up to half of all people do not receive preventive preventable non-communicable diseases, such as heart treatments that are known to be highly effective at disease and stroke, cancer, Type 2 diabetes and liver disease. preventing heart attacks and strokes

Dietary risks • around 90% of people with familial hypercholestero- Tobacco smoke High body-mass index laemia are undiagnosed and untreated despite their High systolic blood pressure Alcohol and drug use average 10 year reduction in life expectancy HIV/AIDS and tuberculosis High fasting plasma glucose Diarrhea, lower respiratory & other common infectious diseases High total cholesterol Neglected tropical diseases & malaria Maternal disorders Low glomerular filtration rate Neonatal disorders Nutritional deficiencies Low physical activity Other communicable, maternal, neonatal, & nutritional diseases Neoplasms Occupational risks Social prescribing and wellbeing hubs offer new Cardiovascular diseases Air pollution Chronic respiratory diseases Cirrhosis Low bone mineral density Digestive diseases models for supporting behaviour change while reducing Neurological disorders Child and maternal malnutrition Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases Sexual abuse and violence burden on general practice. Musculoskeletal disorders Other environmental risks Other non-communicable diseases Transport injuries Unsafe sex Unintentional injuries The NHS Health Check is a systematic approach to Self-harm and interpersonal violence Unsafe water/ sanitation/ handwashing Forces of nature, war, & legal intervention 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% identifying local people at high risk of CVD, offering Percent of total disability-adjusted life-years (DALYs) behaviour change support and early detection of the The Global Burden of Disease Study (next slide) shows us that high risk but often undiagnosed conditions such as the leading causes of premature mortality include diet, hypertension, atrial fibrillation, CKD, diabetes and pre- tobacco, obesity, raised blood pressure, physical inactivity and diabetes. raised cholesterol. The radical upgrade in prevention needs Question: What proportion of our local eligible population-level approaches. But it also needs interventions in population is receiving the NHS Health Check and how primary care for individuals with behavioural and clinical risk effective is the follow-up management of their clinical factors. risk factors in primary care?

11 11 CVD: Primary Care Intelligence Packs Global Burden of Disease Study 2015 Risk Factors for premature death and disability caused by CVD in England, expressed as a percentage of total disability-adjusted life-years

High systolic blood pressure

Dietary risks

High total cholesterol

High body-mass index

Tobacco smoke

High fasting plasma glucose

Low physical activity

Air pollution

Low glomerular filtration rate

Other environmental risks

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%

Percentage of total CVD disability-adjusted life-years (DALYs)

12 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by CCG Comparison with demographically similar CCGs

NHS City and Hackney CCG 21.5%

NHS Haringey CCG 21.1% • prevalence of 19.6% in NHS Lambeth CCG NHS Lewisham CCG 19.8%

NHS Waltham Forest CCG 19.7%

NHS Lambeth CCG 19.6%

NHS Hammersmith and Fulham CCG 19.0%

NHS Greenwich CCG 18.8%

NHS Southwark CCG 18.6% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Newham CCG 18.3% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Brent CCG 16.9% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS Wandsworth CCG 16.4% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 5% 10% 15% 20% 25% recorded as current smokers) divided by GP practice’s estimated number of patients 15+

13 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by GP practice

GP Practice CCG

NORWOOD SURGERY G85113 28.0% HETHERINGTON AT THE PAVILION Y03063 25.1% WATER LANE SURGERY G85088 25.0% THE SOUTH LAMBETH RD PRACTICE G85086 24.1% THE DEERBROOK SURGERY G85129 23.9% BRIXTON HILL GROUP PRACTICE G85025 23.2% • 64,784 people who are recorded as THE CORNER SURGERY G85127 22.7% AKERMAN MEDICAL PRACTICE G85695 22.7% smokers in NHS Lambeth CCG HERNE HILL ROAD MEDICAL PRACTICE G85690 22.6% KNIGHTS HILL SURGERY SUITE 1 G85047 22.5% • GP practice range: 12.2% to 28.0% STOCKWELL GROUP PRACTICE G85028 22.5% THE TULSE HILL PRACTICE G85133 22.4% HETHERINGTON GROUP PRACTICE G85045 22.3% MINET GREEN HEALTH PRACTICE G85135 22.2% THE VAUXHALL SURGERY G85102 22.1% BECKETT HOUSE PRACTICE G85100 21.9% EDITH CAVELL PRACTICE G85724 21.8% THE EXCHANGE SURGERY G85647 21.8% PALACE ROAD SURGERY G85041 21.4% DR WICKREMESINGHE SSG Y00020 21.4% THE STREATHAM HILL GROUP PRACTICE G85662 21.2% MAWBEY GROUP PRACTICE G85130 20.9% DR. MASTERTON'S SURGERY G85021 20.8% STREATHAM HIGH PRACTICE G85002 20.8% BINFIELD ROAD SURGERY G85123 20.2% DR SHEILA SANTAMARIA G85010 20.1% VASSALL MEDICAL CENTRE G85073 20.0% STREATHAM PLACE SURGERY G85118 19.7% LAMBETH WALK GROUP PRACTICE G85054 19.5% HURLEY CLINIC G85053 19.3% PAXTON GREEN GROUP PRACTICE G85039 18.9% THE VALE SURGERY G85096 18.7% SPRINGFIELD MEDICAL CENTRE G85673 18.5% STREATHAM COMMON GROUP PRACTICE G85014 18.3% VALLEY ROAD SURGERY G85044 18.0% DR CURRAN & PARTNERS G85708 17.9% BROCKWELL PARK SURGERY G85137 17.8% CLAPHAM PARK GROUP PRACTICE G85109 16.7% CROWN DALE MEDICAL CENTRE G85022 16.6% Note: This method is thought to be a reasonably HERNE HILL GROUP PRACTICE G85016 16.4% CLAPHAM FAMILY PRACTICE G85011 16.3% robust method in estimating smoking prevalence WATERLOO HEALTH CENTRE G85136 15.7% RIVERSIDE MEDICAL PRACTICE Y01962 15.5% for the majority of GP practices. However, GRAFTON SQUARE SURGERY G85674 14.6% caution is advised for extreme estimates of DR. GUNASUNTHARAM SURGERY G85682 13.3% THE ROSENDALE SURGERY G85706 12.3% smoking prevalence and those with high SANDMERE PRACTICE G85083 12.2% numbers of smoking status not recorded and 0% 5% 10% 15% 20% 25% 30% exceptions.

14 CVD: Primary Care Intelligence Packs Hypertension

15 CVD: Primary Care Intelligence Packs Hypertension

The Missing Millions On average, each CCG in England has 26,000 residents with The Global Burden of Disease undiagnosed hypertension – these individuals are unaware of Study confirmed high blood pressure as their increased cardiovascular risk and are untreated. a leading cause of premature death and disability What questions should we ask in our CCG? 1. for each indicator how wide is the variation in achievement and exception reporting? 2. how many people would benefit if all practices performed High blood pressure is common and costly as well as the best? • it affects around a quarter of all adults 3. how can we support practices who are average or below • the NHS costs of hypertension are around £2bn average to perform as well as the best in: • social costs are probably considerably higher • detection of hypertension • management of hypertension What do we know? • at least half of all heart attacks and strokes are caused by high blood pressure and it is a major risk What might help? factor for chronic kidney disease and cognitive decline • support practices to share audit data and systematically • treatment is very effective – every 10mmHg reduction identify gaps and opportunities for improved detection and in systolic blood pressure lowers risk of heart attack management of hypertension and stroke by 20% • work with practices and local authorities to maximise • despite this 4 out of 10 adults with hypertension, over uptake and follow up in the NHS Health Check 5 and a half million people in England, remain • support access to self-test BP stations in waiting rooms undiagnosed and to ambulatory blood pressure monitoring. • and even when the condition is identified, treatment is • commission community pharmacists to offer blood often suboptimal, with blood pressure poorly pressure measurement, diagnosis and management controlled in about 1 out of 3 individuals support, including support for adherence to medication

16 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by CCG Comparison with CCGs in the STP

NHS Greenwich CCG 0.60

• the ratio of those diagnosed with NHS Bexley CCG 0.59 hypertension versus those expected to have hypertension is 0.51. This compares to 0.59 for England NHS Bromley CCG 0.58 • this suggests that 51% of people with hypertension have been diagnosed

NHS Lewisham CCG 0.56

NHS Southwark CCG 0.55

NHS Lambeth CCG 0.51

Note: this slide shows Hypertension prevalence England 0.59 estimates created using data from QOF hypertension registers 2014/15 and Undiagnosed hypertension estimates for adults 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 16 years and older. 2014. Department of Primary Ratio Care & Public Health, Imperial College London

17 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs

NHS Greenwich CCG 0.60

NHS Newham CCG 0.58

NHS Brent CCG 0.58

NHS Waltham Forest CCG 0.56

NHS Lewisham CCG 0.56

NHS Haringey CCG 0.55

NHS Southwark CCG 0.55

NHS City and Hackney CCG 0.53

NHS Hammersmith and Fulham CCG 0.51

NHS Lambeth CCG 0.51

NHS Wandsworth CCG 0.49

0% 10% 20% 30% 40% 50% 60% 70%

18 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by GP practice

GP practice CCG

NORWOOD SURGERY G85113 0.81 DR. MASTERTON'S SURGERY G85021 0.68 STREATHAM PLACE SURGERY G85118 0.68 DR. GUNASUNTHARAM SURGERY G85682 0.65 SANDMERE PRACTICE G85083 0.61 LAMBETH WALK GROUP PRACTICE G85054 0.60 MINET GREEN HEALTH PRACTICE G85135 0.57 • it is estimated that there are 33,244 THE SOUTH LAMBETH RD PRACTICE G85086 0.57 THE STREATHAM HILL GROUP PRACTICE G85662 0.57 people with undiagnosed THE VAUXHALL SURGERY G85102 0.56 CROWN DALE MEDICAL CENTRE G85022 0.55 hypertension in NHS Lambeth CCG STOCKWELL GROUP PRACTICE G85028 0.55 WATER LANE SURGERY G85088 0.55 • GP practice range of observed to DR WICKREMESINGHE SSG Y00020 0.53 THE TULSE HILL PRACTICE G85133 0.51 expected hypertension prevalence HETHERINGTON GROUP PRACTICE G85045 0.50 HURLEY CLINIC G85053 0.49 0.24 to 0.81 SPRINGFIELD MEDICAL CENTRE G85673 0.49 BINFIELD ROAD SURGERY G85123 0.49 BECKETT HOUSE PRACTICE G85100 0.48 STREATHAM COMMON GROUP PRACTICE G85014 0.48 PALACE ROAD SURGERY G85041 0.48 VALLEY ROAD SURGERY G85044 0.47 MAWBEY GROUP PRACTICE G85130 0.47 THE VALE SURGERY G85096 0.46 THE CORNER SURGERY G85127 0.46 HERNE HILL ROAD MEDICAL PRACTICE G85690 0.45 THE DEERBROOK SURGERY G85129 0.45 DR SHEILA SANTAMARIA G85010 0.45 THE ROSENDALE SURGERY G85706 0.43 PAXTON GREEN GROUP PRACTICE G85039 0.42 BRIXTON HILL GROUP PRACTICE G85025 0.41 CLAPHAM PARK GROUP PRACTICE G85109 0.41 CLAPHAM FAMILY PRACTICE G85011 0.40 THE EXCHANGE SURGERY G85647 0.39 VASSALL MEDICAL CENTRE G85073 0.39 KNIGHTS HILL SURGERY SUITE 1 G85047 0.39 HERNE HILL GROUP PRACTICE G85016 0.38 DR CURRAN & PARTNERS G85708 0.37 HETHERINGTON AT THE PAVILION Y03063 0.34 WATERLOO HEALTH CENTRE G85136 0.34 EDITH CAVELL PRACTICE G85724 0.33 BROCKWELL PARK SURGERY G85137 0.31 STREATHAM HIGH PRACTICE G85002 0.30 AKERMAN MEDICAL PRACTICE G85695 0.28 GRAFTON SQUARE SURGERY G85674 0.25 RIVERSIDE MEDICAL PRACTICE Y01962 0.24 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio

19 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP

NHS Bexley CCG 81.2%

• 36,613 people with hypertension NHS Southwark CCG 79.4% (diagnosed)* in NHS Lambeth CCG • 28,571 (78%) people whose blood pressure is <= 150/90 NHS Lambeth CCG 78.0% • 1,395 (3.8%) people who are excepted from optimal control • 6,647 (18.2%) additional people NHS Bromley CCG 77.3% whose blood pressure is not <= 150/90

NHS Greenwich CCG 76.0%

NHS Lewisham CCG 74.9%

England 79.6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *Using QOF clinical indicator HYP006 denominator plus exceptions

20 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs

NHS City and Hackney CCG 86.3%

NHS Brent CCG 79.8%

NHS Southwark CCG 79.4%

NHS Newham CCG 79.0%

NHS Wandsworth CCG 78.1%

NHS Lambeth CCG 78.0%

NHS Waltham Forest CCG 77.7%

NHS Greenwich CCG 76.0%

NHS Lewisham CCG 74.9%

NHS Haringey CCG 74.7%

NHS Hammersmith and Fulham CCG 74.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

21 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice

No treatment Exceptions reported

THE SOUTH LAMBETH RD PRACTICE G85086 249 THE VALE SURGERY G85096 167 BRIXTON HILL GROUP PRACTICE G85025 244 VASSALL MEDICAL CENTRE G85073 197 DR CURRAN & PARTNERS G85708 189 RIVERSIDE MEDICAL PRACTICE Y01962 89 • in total, including exceptions, there HERNE HILL ROAD MEDICAL PRACTICE G85690 157 DR. GUNASUNTHARAM SURGERY G85682 131 are 8,042 people whose blood HURLEY CLINIC G85053 348 CROWN DALE MEDICAL CENTRE G85022 345 pressure is not <= 150/90 DR SHEILA SANTAMARIA G85010 74 LAMBETH WALK GROUP PRACTICE G85054 287 • GP practice range: 12.2% to 30.9% THE DEERBROOK SURGERY G85129 94 CLAPHAM FAMILY PRACTICE G85011 250 HETHERINGTON GROUP PRACTICE G85045 204 KNIGHTS HILL SURGERY SUITE 1 G85047 117 CLAPHAM PARK GROUP PRACTICE G85109 286 SPRINGFIELD MEDICAL CENTRE G85673 142 DR. MASTERTON'S SURGERY G85021 184 BROCKWELL PARK SURGERY G85137 107 THE VAUXHALL SURGERY G85102 99 BINFIELD ROAD SURGERY G85123 159 PAXTON GREEN GROUP PRACTICE G85039 410 PALACE ROAD SURGERY G85041 182 EDITH CAVELL PRACTICE G85724 146 SANDMERE PRACTICE G85083 375 THE CORNER SURGERY G85127 106 STREATHAM HIGH PRACTICE G85002 144 MINET GREEN HEALTH PRACTICE G85135 288 STREATHAM COMMON GROUP PRACTICE G85014 241 THE STREATHAM HILL GROUP PRACTICE G85662 188 BECKETT HOUSE PRACTICE G85100 115 STOCKWELL GROUP PRACTICE G85028 338 WATERLOO HEALTH CENTRE G85136 129 DR WICKREMESINGHE SSG Y00020 154 GRAFTON SQUARE SURGERY G85674 57 THE TULSE HILL PRACTICE G85133 134 THE EXCHANGE SURGERY G85647 74 HETHERINGTON AT THE PAVILION Y03063 97 NORWOOD SURGERY G85113 97 VALLEY ROAD SURGERY G85044 103 WATER LANE SURGERY G85088 125 AKERMAN MEDICAL PRACTICE G85695 50 MAWBEY GROUP PRACTICE G85130 116 STREATHAM PLACE SURGERY G85118 92 HERNE HILL GROUP PRACTICE G85016 107 THE ROSENDALE SURGERY G85706 55 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

22 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with CCGs in the STP

NHS Lewisham CCG 76.8%

• 129 people with a new diagnosis* of NHS Greenwich CCG 74.5% hypertension with a CVD risk of 20% or higher in NHS Lambeth CCG • 79 (61.2%) people who are currently NHS Southwark CCG 72.7% treated with statins • 41 (31.8%) people who are exempted from treatment with statins NHS Bexley CCG 71.0% • 9 (7%) additional people who are not currently treated with statins

NHS Bromley CCG 66.0%

NHS Lambeth CCG 61.2%

England 66.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *Using the QOF clinical indicator CVD-PP001 denominator plus exceptions

23 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with demographically similar CCGs

NHS Hammersmith and Fulham CCG 84.4%

NHS Newham CCG 78.5%

NHS Lewisham CCG 76.8%

NHS Wandsworth CCG 76.5%

NHS Greenwich CCG 74.5%

NHS Haringey CCG 74.3%

NHS City and Hackney CCG 73.9%

NHS Southwark CCG 72.7%

NHS Waltham Forest CCG 72.5%

NHS Brent CCG 70.1%

NHS Lambeth CCG 61.2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

24 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and not treated with statins by GP practice

No treatment Exceptions reported

STOCKWELL GROUP PRACTICE G85028 10 BINFIELD ROAD SURGERY G85123 2 PAXTON GREEN GROUP PRACTICE G85039 3 KNIGHTS HILL SURGERY SUITE 1 G85047 2 HURLEY CLINIC G85053 2 WATERLOO HEALTH CENTRE G85136 2 • in total, including exceptions, there EDITH CAVELL PRACTICE G85724 2 HERNE HILL GROUP PRACTICE G85016 3 are 50 people who are not treated THE CORNER SURGERY G85127 3 STREATHAM COMMON GROUP PRACTICE G85014 3 with statins HETHERINGTON GROUP PRACTICE G85045 1 BROCKWELL PARK SURGERY G85137 1 • GP practice range: 0.0% to 100.0% SPRINGFIELD MEDICAL CENTRE G85673 1 DR. GUNASUNTHARAM SURGERY G85682 1 DR WICKREMESINGHE SSG Y00020 1 CLAPHAM FAMILY PRACTICE G85011 3 WATER LANE SURGERY G85088 2 MAWBEY GROUP PRACTICE G85130 1 THE TULSE HILL PRACTICE G85133 1 THE EXCHANGE SURGERY G85647 1 STREATHAM HIGH PRACTICE G85002 1 LAMBETH WALK GROUP PRACTICE G85054 1 BECKETT HOUSE PRACTICE G85100 1 CLAPHAM PARK GROUP PRACTICE G85109 1 CROWN DALE MEDICAL CENTRE G85022 1 DR. MASTERTON'S SURGERY G85021 BRIXTON HILL GROUP PRACTICE G85025 PALACE ROAD SURGERY G85041 VALLEY ROAD SURGERY G85044 VASSALL MEDICAL CENTRE G85073 SANDMERE PRACTICE G85083 THE SOUTH LAMBETH RD PRACTICE G85086 THE VALE SURGERY G85096 THE VAUXHALL SURGERY G85102 NORWOOD SURGERY G85113 STREATHAM PLACE SURGERY G85118 MINET GREEN HEALTH PRACTICE G85135 GRAFTON SQUARE SURGERY G85674 HERNE HILL ROAD MEDICAL PRACTICE G85690 AKERMAN MEDICAL PRACTICE G85695 THE ROSENDALE SURGERY G85706 DR CURRAN & PARTNERS G85708 RIVERSIDE MEDICAL PRACTICE Y01962 HETHERINGTON AT THE PAVILION Y03063 THE STREATHAM HILL GROUP PRACTICE G85662 THE DEERBROOK SURGERY G85129 DR SHEILA SANTAMARIA G85010 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

25 CVD: Primary Care Intelligence Packs Stroke

26 CVD: Primary Care Intelligence Packs Stroke prevention

What questions should we ask in our CCG? Only a half of people with known 1. for each indicator how wide is the variation in detection, treatment and exception reporting? AF who then suffer a stroke have been 2. how many people would benefit if all practices anticoagulated before their stroke. performed as well as the best? 3. how can we support practices who are average and below average to perform as well as the best in detection of atrial fibrillation and stroke prevention with anticoagulation. Stroke is one of the leading causes of premature death and disability. Stroke is What might help? devastating for individuals and families, and • increase opportunistic pulse checking especially in over 65s accounts for a substantial proportion of health • support practices to share audit data and systematically and social care expenditure. identify gaps and opportunities for improved detection and management of AF - eg GRASP-AF Atrial fibrillation increases the risk of stroke • promote systematic use of CHADS-VASC and HASBLED to by a factor of 5, and strokes caused by AF are ensure those at high risk are offered stroke prevention often more severe, with higher mortality and • promote systematic use of Warfarin Patient Safety Audit Tool greater disability. to ensure optimal time in therapeutic range for people on Anticoagulation reduces the risk of stroke in warfarin people with AF by two thirds. • develop local consensus statement on risk-benefit balance for Despite this, AF is underdiagnosed and under anticoagulants, including the newer treatments (NOACs) treated: up to a third of people with AF are • work with practices and local authorities to maximise uptake unaware they have the condition and even when and clinical follow up in the NHS Health Check diagnosed inadequate treatment is common – • commission community pharmacists to offer pulse checks, large numbers do not receive anticoagulants or anticoagulant monitoring, and support for adherence to have poor anticoagulant control. medication

27 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with CCGs in the STP

NHS Bromley CCG 0.70

• the ratio of those diagnosed with atrial NHS Bexley CCG 0.66 fibrillation versus those expected to have atrial fibrillation is 0.52. This compares to 0.7 for England NHS Greenwich CCG 0.60 • this suggests that 52% of people with atrial fibrillation have been diagnosed.

NHS Southwark CCG 0.55

NHS Lewisham CCG 0.53

NHS Lambeth CCG 0.52

Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 2015/16 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence Network estimates produced in 2017. The estimates were developed by applying age-sex England 0.70 specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 NHS Digital. Estimates reported are adjusted for age and sex of the local population.

28 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with demographically similar CCGs

NHS Hammersmith and Fulham CCG 0.65

NHS Greenwich CCG 0.60

NHS Wandsworth CCG 0.57

NHS City and Hackney CCG 0.57

NHS Southwark CCG 0.55

NHS Lewisham CCG 0.53

NHS Lambeth CCG 0.52

NHS Haringey CCG 0.52

NHS Waltham Forest CCG 0.51

NHS Brent CCG 0.47

NHS Newham CCG 0.44

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

29 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared with expected prevalence by GP practice

GP practice CCG

BRIXTON HILL GROUP PRACTICE G85025 0.7 LAMBETH WALK GROUP PRACTICE G85054 0.7 WATERLOO HEALTH CENTRE G85136 0.7 DR CURRAN & PARTNERS G85708 0.7 DR SHEILA SANTAMARIA G85010 0.6 STREATHAM COMMON GROUP PRACTICE G85014 0.6 HERNE HILL GROUP PRACTICE G85016 0.6 • it is estimated that there are 4,963 DR. MASTERTON'S SURGERY G85021 0.6 STOCKWELL GROUP PRACTICE G85028 0.6 people with undiagnosed atrial PAXTON GREEN GROUP PRACTICE G85039 0.6 HURLEY CLINIC G85053 0.6 fibrillation in NHS Lambeth CCG CLAPHAM PARK GROUP PRACTICE G85109 0.6 BINFIELD ROAD SURGERY G85123 0.6 • GP practice range of observed to MAWBEY GROUP PRACTICE G85130 0.6 THE EXCHANGE SURGERY G85647 0.6 expected atrial fibrillation prevalence STREATHAM HIGH PRACTICE G85002 0.5 CLAPHAM FAMILY PRACTICE G85011 0.5 0.3 to 0.7 CROWN DALE MEDICAL CENTRE G85022 0.5 PALACE ROAD SURGERY G85041 0.5 HETHERINGTON GROUP PRACTICE G85045 0.5 THE SOUTH LAMBETH RD PRACTICE G85086 0.5 BECKETT HOUSE PRACTICE G85100 0.5 STREATHAM PLACE SURGERY G85118 0.5 THE CORNER SURGERY G85127 0.5 MINET GREEN HEALTH PRACTICE G85135 0.5 THE STREATHAM HILL GROUP PRACTICE G85662 0.5 SPRINGFIELD MEDICAL CENTRE G85673 0.5 GRAFTON SQUARE SURGERY G85674 0.5 VALLEY ROAD SURGERY G85044 0.4 VASSALL MEDICAL CENTRE G85073 0.4 SANDMERE PRACTICE G85083 0.4 THE VALE SURGERY G85096 0.4 NORWOOD SURGERY G85113 0.4 THE DEERBROOK SURGERY G85129 0.4 THE TULSE HILL PRACTICE G85133 0.4 BROCKWELL PARK SURGERY G85137 0.4 HERNE HILL ROAD MEDICAL PRACTICE G85690 0.4 AKERMAN MEDICAL PRACTICE G85695 0.4 THE ROSENDALE SURGERY G85706 0.4 EDITH CAVELL PRACTICE G85724 0.4 DR WICKREMESINGHE SSG Y00020 0.4 RIVERSIDE MEDICAL PRACTICE Y01962 0.4 HETHERINGTON AT THE PAVILION Y03063 0.4 KNIGHTS HILL SURGERY SUITE 1 G85047 0.3 WATER LANE SURGERY G85088 0.3 THE VAUXHALL SURGERY G85102 0.3 DR. GUNASUNTHARAM SURGERY G85682 0.3 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio

30 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by CCG Comparison with CCGs in the STP Optimal management No treatment Exceptions reported

NHS Bromley CCG 76.7% • 2,023 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS Lambeth CCG 76.3% NHS Lambeth CCG • 1,543 (76.3%) people treated with anti-coagulation therapy NHS Bexley CCG 75.8% • 249 (12.3%) people who are exceptions • 231 (11.4%) additional people with a NHS Southwark CCG 75.2% recorded CHA2DS2-VASc score >= 2 who are not treated

NHS Lewisham CCG 71.1%

NHS Greenwich CCG 70.4%

England 77.9%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator AF007 denominator plus exceptions

31 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported

NHS Newham CCG 77.7%

NHS City and Hackney CCG 76.5%

NHS Hammersmith and Fulham CCG 76.4%

NHS Lambeth CCG 76.3%

NHS Waltham Forest CCG 75.7%

NHS Southwark CCG 75.2%

NHS Wandsworth CCG 75.1%

NHS Lewisham CCG 71.1%

NHS Haringey CCG 71.1%

NHS Greenwich CCG 70.4%

NHS Brent CCG 68.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

32 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by GP practice

No treatment Exceptions reported

BECKETT HOUSE PRACTICE G85100 13 DR. MASTERTON'S SURGERY G85021 32 THE DEERBROOK SURGERY G85129 6 WATERLOO HEALTH CENTRE G85136 18 AKERMAN MEDICAL PRACTICE G85695 4 NORWOOD SURGERY G85113 6 • in total, including exceptions, there GRAFTON SQUARE SURGERY G85674 5 KNIGHTS HILL SURGERY SUITE 1 G85047 6 are 480 people with a recorded LAMBETH WALK GROUP PRACTICE G85054 27 SPRINGFIELD MEDICAL CENTRE G85673 9 CHA2DS2-VASc score >= 2 who are DR. GUNASUNTHARAM SURGERY G85682 3 EDITH CAVELL PRACTICE G85724 7 not treated THE SOUTH LAMBETH RD PRACTICE G85086 10 HERNE HILL GROUP PRACTICE G85016 19 • GP practice range: 7.4% to 48.1% CLAPHAM FAMILY PRACTICE G85011 17 CLAPHAM PARK GROUP PRACTICE G85109 23 HETHERINGTON AT THE PAVILION Y03063 4 STREATHAM PLACE SURGERY G85118 7 THE CORNER SURGERY G85127 7 THE EXCHANGE SURGERY G85647 6 HERNE HILL ROAD MEDICAL PRACTICE G85690 5 STREATHAM COMMON GROUP PRACTICE G85014 23 THE STREATHAM HILL GROUP PRACTICE G85662 12 STOCKWELL GROUP PRACTICE G85028 25 SANDMERE PRACTICE G85083 12 DR CURRAN & PARTNERS G85708 12 BRIXTON HILL GROUP PRACTICE G85025 12 THE VAUXHALL SURGERY G85102 3 BINFIELD ROAD SURGERY G85123 10 CROWN DALE MEDICAL CENTRE G85022 17 HETHERINGTON GROUP PRACTICE G85045 10 MINET GREEN HEALTH PRACTICE G85135 11 PAXTON GREEN GROUP PRACTICE G85039 31 THE VALE SURGERY G85096 4 STREATHAM HIGH PRACTICE G85002 6 DR SHEILA SANTAMARIA G85010 3 HURLEY CLINIC G85053 16 VASSALL MEDICAL CENTRE G85073 5 MAWBEY GROUP PRACTICE G85130 7 BROCKWELL PARK SURGERY G85137 4 WATER LANE SURGERY G85088 3 DR WICKREMESINGHE SSG Y00020 5 THE ROSENDALE SURGERY G85706 4 PALACE ROAD SURGERY G85041 5 RIVERSIDE MEDICAL PRACTICE Y01962 1 VALLEY ROAD SURGERY G85044 3 THE TULSE HILL PRACTICE G85133 2 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

33 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by GP practice – opportunities compared to GP cluster

15% 10% 5% 0% -5% -10% -15% -20% -25% -30% -35%

BECKETT HOUSE PRACTICE 9

DR. MASTERTON'S SURGERY 21

THE DEERBROOK SURGERY 4 • using the GP cluster method of AKERMAN MEDICAL PRACTICE 2 calculating potential gains, if each WATERLOO HEALTH CENTRE 10 practice was to achieve as well as the NORWOOD SURGERY 3 upper quartile of its national cluster, then an additional 157 people would GRAFTON SQUARE SURGERY 2 be treated DR. GUNASUNTHARAM SURGERY 1

SPRINGFIELD MEDICAL CENTRE 4

LAMBETH WALK GROUP PRACTICE 13

VASSALL MEDICAL CENTRE 0

MAWBEY GROUP PRACTICE

BROCKWELL PARK SURGERY

DR WICKREMESINGHE SSG

WATER LANE SURGERY

THE ROSENDALE SURGERY

PALACE ROAD SURGERY

VALLEY ROAD SURGERY

RIVERSIDE MEDICAL PRACTICE

THE TULSE HILL PRACTICE Details of this methodology are available on slide 9. Click here to view them.

34 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP

Below 150/90 Not below 150/90 Exceptions reported

NHS Southwark CCG 86.4% • 3,640 people with a history of stroke or TIA* in NHS Lambeth CCG NHS Bexley CCG 85.3% • 3,102 (85.2%) people whose blood pressure is <= 150 / 90 • 144 (4%) people who are exceptions NHS Lambeth CCG 85.2% • 394 (10.8%) additional people whose blood pressure is not <= 150 / 90

NHS Greenwich CCG 83.3%

NHS Bromley CCG 81.8%

NHS Lewisham CCG 80.8%

England 83.8%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA003 denominator plus exceptions

35 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported

NHS City and Hackney CCG 93.3%

NHS Southwark CCG 86.4%

NHS Lambeth CCG 85.2%

NHS Brent CCG 84.2%

NHS Newham CCG 83.6%

NHS Greenwich CCG 83.3%

NHS Waltham Forest CCG 82.9%

NHS Wandsworth CCG 82.5%

NHS Lewisham CCG 80.8%

NHS Hammersmith and Fulham CCG 80.3%

NHS Haringey CCG 78.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

36 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice

No treatment Exceptions reported

CLAPHAM FAMILY PRACTICE G85011 31 KNIGHTS HILL SURGERY SUITE 1 G85047 13 DR CURRAN & PARTNERS G85708 22 MINET GREEN HEALTH PRACTICE G85135 28 BINFIELD ROAD SURGERY G85123 13 VASSALL MEDICAL CENTRE G85073 17 • in total, including exceptions, there DR SHEILA SANTAMARIA G85010 6 THE SOUTH LAMBETH RD PRACTICE G85086 15 are 538 people whose blood pressure HERNE HILL ROAD MEDICAL PRACTICE G85690 10 DR WICKREMESINGHE SSG Y00020 11 is not <= 150 / 90 DR. GUNASUNTHARAM SURGERY G85682 6 THE VALE SURGERY G85096 8 • GP practice range: 0.0% to 26.3% PAXTON GREEN GROUP PRACTICE G85039 44 HURLEY CLINIC G85053 23 EDITH CAVELL PRACTICE G85724 8 STOCKWELL GROUP PRACTICE G85028 28 BRIXTON HILL GROUP PRACTICE G85025 14 THE DEERBROOK SURGERY G85129 8 RIVERSIDE MEDICAL PRACTICE Y01962 4 LAMBETH WALK GROUP PRACTICE G85054 19 THE CORNER SURGERY G85127 7 CLAPHAM PARK GROUP PRACTICE G85109 23 SPRINGFIELD MEDICAL CENTRE G85673 8 WATERLOO HEALTH CENTRE G85136 9 HETHERINGTON GROUP PRACTICE G85045 15 GRAFTON SQUARE SURGERY G85674 5 BROCKWELL PARK SURGERY G85137 8 STREATHAM HIGH PRACTICE G85002 8 THE VAUXHALL SURGERY G85102 6 WATER LANE SURGERY G85088 10 HERNE HILL GROUP PRACTICE G85016 13 DR. MASTERTON'S SURGERY G85021 17 PALACE ROAD SURGERY G85041 8 CROWN DALE MEDICAL CENTRE G85022 18 THE STREATHAM HILL GROUP PRACTICE G85662 7 BECKETT HOUSE PRACTICE G85100 5 NORWOOD SURGERY G85113 5 THE ROSENDALE SURGERY G85706 4 MAWBEY GROUP PRACTICE G85130 6 VALLEY ROAD SURGERY G85044 4 HETHERINGTON AT THE PAVILION Y03063 4 SANDMERE PRACTICE G85083 6 STREATHAM COMMON GROUP PRACTICE G85014 7 THE EXCHANGE SURGERY G85647 2 THE TULSE HILL PRACTICE G85133 4 AKERMAN MEDICAL PRACTICE G85695 1 STREATHAM PLACE SURGERY G85118 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

37 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with CCGs in the STP Below 150/90 Not below 150/90 Exceptions reported

NHS Bexley CCG 92.7% • 1,769 people with a stroke shown to be non-haemorrhagic* in NHS NHS Southwark CCG 92.5% Lambeth CCG • 1,591 (89.9%) people who are taking an anti-platetet agent or anti- NHS Bromley CCG 91.4% coagulant • 118 (6.7%) people who are exceptions NHS Lewisham CCG 91.0% • 60 (3.4%) additional people with no treatment

NHS Greenwich CCG 90.9%

NHS Lambeth CCG 89.9%

England 91.8%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA007 denominator plus exceptions

38 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported

NHS Southwark CCG 92.5%

NHS Newham CCG 91.0%

NHS Lewisham CCG 91.0%

NHS Greenwich CCG 90.9%

NHS Waltham Forest CCG 90.9%

NHS City and Hackney CCG 90.8%

NHS Brent CCG 90.4%

NHS Wandsworth CCG 90.3%

NHS Hammersmith and Fulham CCG 90.2%

NHS Lambeth CCG 89.9%

NHS Haringey CCG 88.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

39 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who do not have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by GP practice

No treatment Exceptions reported

DR. GUNASUNTHARAM SURGERY G85682 6 AKERMAN MEDICAL PRACTICE G85695 3 RIVERSIDE MEDICAL PRACTICE Y01962 2 MINET GREEN HEALTH PRACTICE G85135 11 GRAFTON SQUARE SURGERY G85674 3 DR SHEILA SANTAMARIA G85010 4 • in total, including exceptions, there CROWN DALE MEDICAL CENTRE G85022 19 NORWOOD SURGERY G85113 5 are 178 people who are not taking an THE DEERBROOK SURGERY G85129 5 THE STREATHAM HILL GROUP PRACTICE G85662 6 anti-platelet agent or anti-coagulant CLAPHAM FAMILY PRACTICE G85011 7 WATERLOO HEALTH CENTRE G85136 3 • GP practice range: 0.0% to 33.3% SPRINGFIELD MEDICAL CENTRE G85673 3 DR WICKREMESINGHE SSG Y00020 4 DR. MASTERTON'S SURGERY G85021 8 THE SOUTH LAMBETH RD PRACTICE G85086 5 HURLEY CLINIC G85053 6 VALLEY ROAD SURGERY G85044 4 CLAPHAM PARK GROUP PRACTICE G85109 11 PAXTON GREEN GROUP PRACTICE G85039 16 THE CORNER SURGERY G85127 2 KNIGHTS HILL SURGERY SUITE 1 G85047 3 BRIXTON HILL GROUP PRACTICE G85025 3 THE VAUXHALL SURGERY G85102 2 LAMBETH WALK GROUP PRACTICE G85054 4 STREATHAM PLACE SURGERY G85118 2 STOCKWELL GROUP PRACTICE G85028 6 HERNE HILL ROAD MEDICAL PRACTICE G85690 2 STREATHAM COMMON GROUP PRACTICE G85014 5 BECKETT HOUSE PRACTICE G85100 2 BINFIELD ROAD SURGERY G85123 2 DR CURRAN & PARTNERS G85708 2 HETHERINGTON AT THE PAVILION Y03063 1 MAWBEY GROUP PRACTICE G85130 2 EDITH CAVELL PRACTICE G85724 1 SANDMERE PRACTICE G85083 2 VASSALL MEDICAL CENTRE G85073 1 BROCKWELL PARK SURGERY G85137 1 PALACE ROAD SURGERY G85041 1 WATER LANE SURGERY G85088 1 HETHERINGTON GROUP PRACTICE G85045 1 HERNE HILL GROUP PRACTICE G85016 1 STREATHAM HIGH PRACTICE G85002 THE VALE SURGERY G85096 THE TULSE HILL PRACTICE G85133 THE EXCHANGE SURGERY G85647 THE ROSENDALE SURGERY G85706 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

40 CVD: Primary Care Intelligence Packs Diabetes

41 CVD: Primary Care Intelligence Packs Diabetes prevention and management

Type 2 Diabetes in numbers Diabetes costs the NHS • diagnosed prevalence – 3.0 million £9.8 billion per year – and the • undiagnosed diabetes – 900,000 • non-diabetic hyperglycaemia (high risk of diabetes) – 5 million prevalence is rising What questions should we ask in our CCG? 1. for each indicator how wide is the variation in achievement and exception reporting? Type 2 diabetes is often preventable 2. how many people would benefit if all practices performed as well People at high risk of developing type 2 diabetes as the best? can be identified through the NHS Health Check, 3. how can we support practices who are average and below and the disease can be prevented or delayed in average to perform as well as the best in: many through intensive behaviour change support. • detection of diabetes • delivery of the 8 care processes and achievement of the 3 treatment targets Complications of diabetes are preventable • identification and management of Non-diabetic hyperglycaemia Diabetes is a major cause of premature death and disability and greatly increases the risk of heart disease and stroke, kidney failure, amputations and What might help blindness. 80% of NHS spending on diabetes goes • ensure universal participation by practices in the National on managing these complications, most of which Diabetes Audit (NDA) could be prevented. There are 8 essential care • benchmark practice level data from the NDA – and support processes, in addition to retinal screening, that practices to explore variation together substantially reduce complication rates. • increase support for patient education and shared Despite this, around a half of people with diabetes management do not receive all 8 care processes, and there is • maximise uptake of the NHS Health Check to aid detection of widespread variation between CCGs and practices diabetes and Non Diabetic Hyperglycaemia in levels of achievement • maximise uptake of the NHS Diabetes Prevention Programme

42 CVD: Primary Care Intelligence Packs Diabetes observed prevalence compared with expected prevalence by CCG Comparison with CCGs in the STP

NHS Bexley CCG 0.84 • 0.58 ratio of observed to expected diabetes prevalence in NHS Lambeth NHS Greenwich CCG 0.80 CCG, compared to 0.77 in England

NHS Bromley CCG 0.67 • this suggests 58% of people have been diagnosed

NHS Lewisham CCG 0.66

NHS Southwark CCG 0.65

NHS Lambeth CCG 0.58

Note: This slide compares the prevalence of Diabetes recorded in QOF in 2015/16 to the expected prevalence of Diabetes in 2016 taken England 0.77 from the NCVIN diabetes prevalence model produced in 2015.

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

43 CVD: Primary Care Intelligence Packs Diabetes observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs

NHS Newham CCG 0.83

NHS Greenwich CCG 0.80

NHS Brent CCG 0.78

NHS Waltham Forest CCG 0.67

NHS Lewisham CCG 0.66

NHS Haringey CCG 0.65

NHS Southwark CCG 0.65

NHS Wandsworth CCG 0.62

NHS City and Hackney CCG 0.61

NHS Hammersmith and Fulham CCG 0.60

NHS Lambeth CCG 0.58

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

44 CVD: Primary Care Intelligence Packs Diabetes prevalence by GP practice

GP practice CCG

DR. GUNASUNTHARAM SURGERY G85682 15.5% THE VALE SURGERY G85096 9.1% STREATHAM PLACE SURGERY G85118 8.9% DR. MASTERTON'S SURGERY G85021 8.8% THE VAUXHALL SURGERY G85102 8.5% NORWOOD SURGERY G85113 8.2% • GP practice range of observed DR WICKREMESINGHE SSG Y00020 7.7% STOCKWELL GROUP PRACTICE G85028 7.6% diabetes 1.3% to 15.5% SANDMERE PRACTICE G85083 7.6% MINET GREEN HEALTH PRACTICE G85135 7.4% • there are an estimated 12,308 people WATER LANE SURGERY G85088 7.3% CROWN DALE MEDICAL CENTRE G85022 7.1% with undiagnosed diabetes in NHS LAMBETH WALK GROUP PRACTICE G85054 6.9% STREATHAM COMMON GROUP PRACTICE G85014 6.8% Lambeth CCG THE TULSE HILL PRACTICE G85133 6.5% THE STREATHAM HILL GROUP PRACTICE G85662 6.4% THE SOUTH LAMBETH RD PRACTICE G85086 6.4% PALACE ROAD SURGERY G85041 6.1% SPRINGFIELD MEDICAL CENTRE G85673 6.1% BINFIELD ROAD SURGERY G85123 6.0% MAWBEY GROUP PRACTICE G85130 6.0% THE DEERBROOK SURGERY G85129 5.9% HURLEY CLINIC G85053 5.7% HETHERINGTON GROUP PRACTICE G85045 5.6% HERNE HILL ROAD MEDICAL PRACTICE G85690 5.5% VASSALL MEDICAL CENTRE G85073 5.2% PAXTON GREEN GROUP PRACTICE G85039 5.2% VALLEY ROAD SURGERY G85044 5.1% THE CORNER SURGERY G85127 5.0% BECKETT HOUSE PRACTICE G85100 4.8% BRIXTON HILL GROUP PRACTICE G85025 4.7% KNIGHTS HILL SURGERY SUITE 1 G85047 4.5% THE EXCHANGE SURGERY G85647 4.4% HETHERINGTON AT THE PAVILION Y03063 4.4% CLAPHAM PARK GROUP PRACTICE G85109 4.2% DR SHEILA SANTAMARIA G85010 4.1% AKERMAN MEDICAL PRACTICE G85695 4.0% THE ROSENDALE SURGERY G85706 3.9% DR CURRAN & PARTNERS G85708 3.6% HERNE HILL GROUP PRACTICE G85016 3.4% CLAPHAM FAMILY PRACTICE G85011 3.3% STREATHAM HIGH PRACTICE G85002 3.2% BROCKWELL PARK SURGERY G85137 2.9% WATERLOO HEALTH CENTRE G85136 2.9% Note: The estimated number of undiagnosed GRAFTON SQUARE SURGERY G85674 2.7% EDITH CAVELL PRACTICE G85724 2.6% people with diabetes has been calculated by RIVERSIDE MEDICAL PRACTICE Y01962 1.3% multiplying the estimated prevalence rate to the 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 2015/16 QOF list size and subtracting the number of people on the diabetes register.

45 CVD: Primary Care Intelligence Packs Expected total prevalence of diabetes and non-diabetic hyperglycaemia

Diabetes prevalence Undiagnosed diabetes prevalence Expected non-diabetic hyperglycaemia prevalence

• the estimated total prevalence of NHS Lewisham CCG 6.4% 3.3% 11.1% diabetes in NHS Lambeth CCG is 9.1% (diagnosed and undiagnosed) NHS Bexley CCG 6.9% 1.3% 11.5% • in addition, there are an estimated 9.7% of people in NHS Lambeth CCG NHS Bromley CCG 5.5% 2.7% 11.4% who are at increased risk of developing diabetes (i.e. with non- diabetic hyperglycaemia) NHS Southwark CCG 5.9% 3.2% 10.2%

• this means that 18.9% of the NHS Lambeth CCG 5.3% 3.8% 9.7% population in NHS Lambeth CCG are estimated to have diabetes, or at high risk of developing of diabetes NHS Greenwich CCG 6.7% 1.7% 10.3%

Note: Prevalence estimates of non-diabetic hyperglycaemia were developed using Health Survey for England (HSE) data. Five years of England 6.5% 1.9% 11.2% HSE data were combined, 2009- 2013. The estimates take into account the age, ethnic group and estimated body mass index of the population. 0% 5% 10% 15% 20% 25% These estimates were produced using the GP registered population.

46 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by CCG 2015/16

NHS Bexley CCG 49.5%

• data on care processes and treatment NHS Greenwich CCG 43.3% targets are taken from the National Diabetes Audit (NDA) • overall practice participation in the NHS Lambeth CCG 43.1% 2015/16 audit was 81.4% in England

• in NHS Lambeth CCG, 47 out of 47 NHS Bromley CCG 41.2% practices (100.0%) participated in the NDA

NHS Southwark CCG 39.7%

• 43.1% of people with diabetes (of NHS Lewisham CCG 33.7% practices who participated in the audit) had the eight recommended care processes in NHS Lambeth CCG, compared to 52.6% in England

England 52.6%

0% 10% 20% 30% 40% 50% 60%

47 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by GP practice, 2015/16

GP practice Average of practices in the CCG who participated in the audit

THE EXCHANGE SURGERY G85647 81.1% MAWBEY GROUP PRACTICE G85130 80.0% DR SHEILA SANTAMARIA G85010 79.6% BECKETT HOUSE PRACTICE G85100 77.0% WATER LANE SURGERY G85088 72.2% • achievement - 8 care processes: in WATERLOO HEALTH CENTRE G85136 70.8% STOCKWELL GROUP PRACTICE G85028 69.7% practices who provided data via the VALLEY ROAD SURGERY G85044 64.8% BROCKWELL PARK SURGERY G85137 64.2% NDA, between 9.7% and 81.1% of STREATHAM COMMON GROUP PRACTICE G85014 63.8% NORWOOD SURGERY G85113 63.8% patients received all 8 care processes SPRINGFIELD MEDICAL CENTRE G85673 61.5% THE CORNER SURGERY G85127 58.8% STREATHAM HIGH PRACTICE G85002 53.9% DR WICKREMESINGHE SSG Y00020 53.4% CLAPHAM PARK GROUP PRACTICE G85109 52.9% • at least 9,488 people did not receive THE SOUTH LAMBETH RD PRACTICE G85086 52.4% EDITH CAVELL PRACTICE G85724 51.5% the eight care processes HETHERINGTON AT THE PAVILION Y03063 50.4% DR. GUNASUNTHARAM SURGERY G85682 49.8% DR. MASTERTON'S SURGERY G85021 47.4% SANDMERE PRACTICE G85083 47.0% BINFIELD ROAD SURGERY G85123 45.0% KNIGHTS HILL SURGERY SUITE 1 G85047 42.1% CLAPHAM FAMILY PRACTICE G85011 39.6% THE STREATHAM HILL GROUP PRACTICE G85662 39.4% HERNE HILL GROUP PRACTICE G85016 39.0% LAMBETH WALK GROUP PRACTICE G85054 37.8% HURLEY CLINIC G85053 34.7% DR CURRAN & PARTNERS G85708 33.9% THE TULSE HILL PRACTICE G85133 32.6% RIVERSIDE MEDICAL PRACTICE Y01962 29.5% THE ROSENDALE SURGERY G85706 29.3% HETHERINGTON GROUP PRACTICE G85045 27.6% THE VALE SURGERY G85096 26.9% HERNE HILL ROAD MEDICAL PRACTICE G85690 26.4% VASSALL MEDICAL CENTRE G85073 23.4% MINET GREEN HEALTH PRACTICE G85135 22.7% BRIXTON HILL GROUP PRACTICE G85025 22.6% PALACE ROAD SURGERY G85041 21.9% STREATHAM PLACE SURGERY G85118 21.8% CROWN DALE MEDICAL CENTRE G85022 19.9% AKERMAN MEDICAL PRACTICE G85695 19.8% THE DEERBROOK SURGERY G85129 17.9% PAXTON GREEN GROUP PRACTICE G85039 10.8% THE VAUXHALL SURGERY G85102 10.0% GRAFTON SQUARE SURGERY G85674 9.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

48 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by CCG, 2015/16

NHS Bexley CCG 45.9%

• 35.7% of people with diabetes (of NHS Bromley CCG 42.0% practices who participated in the audit) met the three treatment targets in NHS Lambeth CCG, compared to 39.0% in England NHS Greenwich CCG 39.9%

NHS Southwark CCG 37.0%

NHS Lambeth CCG 35.7%

NHS Lewisham CCG 35.5%

England 39.0%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

49 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16

GP practice Average of practices in the CCG who participated in the audit

DR. GUNASUNTHARAM SURGERY G85682 53.9% NORWOOD SURGERY G85113 52.0% THE VAUXHALL SURGERY G85102 49.8% GRAFTON SQUARE SURGERY G85674 47.7% VALLEY ROAD SURGERY G85044 47.4% • achievement - 3 treatment targets: in BECKETT HOUSE PRACTICE G85100 46.4% THE TULSE HILL PRACTICE G85133 43.5% practices who provided data via the MAWBEY GROUP PRACTICE G85130 43.4% DR. MASTERTON'S SURGERY G85021 42.9% NDA, between 23.1% and 53.9% of THE ROSENDALE SURGERY G85706 42.6% THE STREATHAM HILL GROUP PRACTICE G85662 41.6% patients achieved all 3 treatment THE VALE SURGERY G85096 41.4% THE DEERBROOK SURGERY G85129 40.0% targets THE EXCHANGE SURGERY G85647 39.7% STREATHAM HIGH PRACTICE G85002 39.3% SANDMERE PRACTICE G85083 38.5% • at least 9,688 people did not meet the STREATHAM PLACE SURGERY G85118 38.2% STREATHAM COMMON GROUP PRACTICE G85014 38.0% three treatment targets SPRINGFIELD MEDICAL CENTRE G85673 37.2% VASSALL MEDICAL CENTRE G85073 36.9% HETHERINGTON AT THE PAVILION Y03063 36.7% EDITH CAVELL PRACTICE G85724 35.7% CLAPHAM FAMILY PRACTICE G85011 35.6% WATER LANE SURGERY G85088 34.2% AKERMAN MEDICAL PRACTICE G85695 34.0% HERNE HILL GROUP PRACTICE G85016 33.9% PALACE ROAD SURGERY G85041 33.9% CROWN DALE MEDICAL CENTRE G85022 33.7% WATERLOO HEALTH CENTRE G85136 32.8% THE CORNER SURGERY G85127 32.6% PAXTON GREEN GROUP PRACTICE G85039 32.2% CLAPHAM PARK GROUP PRACTICE G85109 32.2% DR WICKREMESINGHE SSG Y00020 32.0% STOCKWELL GROUP PRACTICE G85028 31.9% HURLEY CLINIC G85053 31.7% RIVERSIDE MEDICAL PRACTICE Y01962 31.2% MINET GREEN HEALTH PRACTICE G85135 30.9% THE SOUTH LAMBETH RD PRACTICE G85086 29.8% BINFIELD ROAD SURGERY G85123 29.4% BRIXTON HILL GROUP PRACTICE G85025 28.0% HERNE HILL ROAD MEDICAL PRACTICE G85690 27.8% KNIGHTS HILL SURGERY SUITE 1 G85047 27.3% DR CURRAN & PARTNERS G85708 27.0% HETHERINGTON GROUP PRACTICE G85045 26.8% LAMBETH WALK GROUP PRACTICE G85054 26.7% BROCKWELL PARK SURGERY G85137 24.5% DR SHEILA SANTAMARIA G85010 23.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

50 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16 - opportunities compared to GP cluster

15% 10% 5% 0% -5% -10% -15% -20% -25%

DR SHEILA SANTAMARIA 23

BROCKWELL PARK SURGERY 34

LAMBETH WALK GROUP PRACTICE 75 • using the GP cluster method of HETHERINGTON GROUP PRACTICE 65 calculating potential gains, if each DR CURRAN & PARTNERS 47 practice was to achieve as well as the KNIGHTS HILL SURGERY SUITE 1 32 upper quartile of its national cluster, then an additional 1,402 people would BRIXTON HILL GROUP PRACTICE 62 be treated HERNE HILL ROAD MEDICAL PRACTICE 38

BINFIELD ROAD SURGERY 45

THE SOUTH LAMBETH RD PRACTICE 49

THE STREATHAM HILL GROUP PRACTICE 12

THE ROSENDALE SURGERY 4

MAWBEY GROUP PRACTICE 8

THE TULSE HILL PRACTICE 2

BECKETT HOUSE PRACTICE

VALLEY ROAD SURGERY

THE VAUXHALL SURGERY

GRAFTON SQUARE SURGERY

NORWOOD SURGERY

DR. GUNASUNTHARAM SURGERY Details of this methodology are available on slide 9. Click here to view them.

51 CVD: Primary Care Intelligence Packs Kidney

52 CVD: Primary Care Intelligence Packs Management of chronic kidney disease

Chronic Kidney Disease can progress to kidney failure and it Late diagnosis of CKD is common. substantially increases the risk Around a third of people with CKD are undiagnosed. More of heart attack and stroke. opportunistic testing and improved uptake of the NHS Health Check will increase detection rates.

Chronic Kidney Disease (CKD) is common. What questions should we ask in our CCG? It is one of the commonest co-morbidities and affects a third 1. for each indicator how wide is the variation in of people over 75. In 2010 it was estimated to cost the NHS achievement and exception reporting? around £1.5bn. Average length of stay in hospital tends to 2. how many people would benefit if all practices be longer and outcomes are considerably worse: performed as well as the best? approximately 7,000 excess strokes and 12,000 excess 3. how can we support practices who are average and heart attacks occur each year in people with CKD below average to perform as well as the best in: compared to those without. • detection of CKD Individuals with CKD are also at much higher risk of • more systematic delivery of evidence based care developing acute kidney injury when they have an intercurrent illness such as pneumonia What might help • Support practices to share audit data and systematically Evidence based guidance from NICE highlights CVD identify gaps and opportunities for improved detection risk reduction, good blood pressure control and and management of CKD. management of proteinuria as essential steps to reduce the • Promote uptake of and follow up from the NHS Health risk of cardiovascular events and progression to kidney Check to aid detection and management of CKD failure. Despite this there is often significant variation • Offer local training and education in the detection and between practices in achievement and exception reporting. management of CKD

53 CVD: Primary Care Intelligence Packs Chronic kidney disease (CKD) observed prevalence (2015/16) compared with expected prevalence (2011) by CCG Comparison with CCGs in the STP

NHS Greenwich CCG 0.67

NHS Southwark CCG 0.61 • the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney NHS Lambeth CCG 0.55 disease is 0.55. This compares to 0.68 for England • this suggests that 55% of people with NHS Bromley CCG 0.55 chronic kidney disease have been diagnosed

NHS Bexley CCG 0.55

NHS Lewisham CCG 0.49

Note: This slide compares the prevalence of CKD recorded in QOF in 2015/16 to the expected prevalence of CKD produced by the University of Southampton in 2011. A small number of CCGs have a ratio greater than 1. It is unlikely that all England 0.68 people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.

54 CVD: Primary Care Intelligence Packs Chronic kidney disease (CKD) observed prevalence (2015/16) compared with expected prevalence (2011) by CCG Comparison with demographically similar CCGs

NHS Greenwich CCG 0.67

NHS Southwark CCG 0.61

NHS City and Hackney CCG 0.61

NHS Newham CCG 0.60

NHS Lambeth CCG 0.55

NHS Hammersmith and Fulham CCG 0.55

NHS Waltham Forest CCG 0.52

NHS Haringey CCG 0.50

NHS Brent CCG 0.49

NHS Lewisham CCG 0.49

NHS Wandsworth CCG 0.42

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Ratio

55 CVD: Primary Care Intelligence Packs CKD prevalence by GP practice, 2015/16

GP practice CCG

LAMBETH WALK GROUP PRACTICE G85054 3.8% STREATHAM PLACE SURGERY G85118 3.5% STREATHAM COMMON GROUP PRACTICE G85014 3.2% THE SOUTH LAMBETH RD PRACTICE G85086 2.9% STOCKWELL GROUP PRACTICE G85028 2.8% THE EXCHANGE SURGERY G85647 2.8% • it is estimated that there are 4,600 DR. MASTERTON'S SURGERY G85021 2.8% NORWOOD SURGERY G85113 2.7% people with undiagnosed chronic HETHERINGTON GROUP PRACTICE G85045 2.4% BINFIELD ROAD SURGERY G85123 2.4% kidney disease in NHS Lambeth CCG CROWN DALE MEDICAL CENTRE G85022 2.4% DR SHEILA SANTAMARIA G85010 2.3% • GP practice range of observed CKD: HURLEY CLINIC G85053 2.2% VASSALL MEDICAL CENTRE G85073 2.1% 0.5% to 3.8% THE TULSE HILL PRACTICE G85133 2.1% VALLEY ROAD SURGERY G85044 2.1% THE STREATHAM HILL GROUP PRACTICE G85662 2.0% PAXTON GREEN GROUP PRACTICE G85039 2.0% THE ROSENDALE SURGERY G85706 1.9% AKERMAN MEDICAL PRACTICE G85695 1.9% DR WICKREMESINGHE SSG Y00020 1.8% THE VAUXHALL SURGERY G85102 1.8% DR CURRAN & PARTNERS G85708 1.8% CLAPHAM PARK GROUP PRACTICE G85109 1.8% DR. GUNASUNTHARAM SURGERY G85682 1.8% SPRINGFIELD MEDICAL CENTRE G85673 1.7% BRIXTON HILL GROUP PRACTICE G85025 1.6% PALACE ROAD SURGERY G85041 1.6% HERNE HILL ROAD MEDICAL PRACTICE G85690 1.6% HETHERINGTON AT THE PAVILION Y03063 1.6% THE DEERBROOK SURGERY G85129 1.6% MINET GREEN HEALTH PRACTICE G85135 1.6% SANDMERE PRACTICE G85083 1.5% MAWBEY GROUP PRACTICE G85130 1.5% KNIGHTS HILL SURGERY SUITE 1 G85047 1.4% THE CORNER SURGERY G85127 1.3% WATER LANE SURGERY G85088 1.3% HERNE HILL GROUP PRACTICE G85016 1.2% WATERLOO HEALTH CENTRE G85136 1.2% GRAFTON SQUARE SURGERY G85674 1.2% BECKETT HOUSE PRACTICE G85100 1.2% Note: CCG estimates for the estimated CLAPHAM FAMILY PRACTICE G85011 1.2% THE VALE SURGERY G85096 1.1% number of people with CKD are based on BROCKWELL PARK SURGERY G85137 0.8% EDITH CAVELL PRACTICE G85724 0.8% applying a proportion from a resident based STREATHAM HIGH PRACTICE G85002 0.7% population estimate to a GP registered RIVERSIDE MEDICAL PRACTICE Y01962 0.5% population. The characteristics of registered 0% 1% 1% 2% 2% 3% 3% 4% 4% and resident populations may vary in some CCGs, and local interpretation is required.

56 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less by CCG, 2014/15 Comparison with CCGs in the STP Below 140/85 Not below 140/85 Exceptions reported

NHS Bexley CCG 77.8% • 5,705 people with CKD (diagnosed*) in NHS Lambeth CCG NHS Greenwich CCG 76.7% • 4,254 (74.6%) people whose blood pressure is <= 140 /85 • 466 (8.2%) people who are NHS Southwark CCG 75.2% exceptions • 985 (17.3%) additional people whose blood pressure is not <= 140 / 85 NHS Lambeth CCG 74.6%

NHS Lewisham CCG 74.0%

NHS Bromley CCG 70.8%

*Using the QOF clinical indicator CKD002 England 74.4% denominator plus exceptions. Note: as the CKD002 indicator was removed from 0% 20% 40% 60% 80% 100% the QOF in 15/16 this is historic data taken from the 2014/15 QOF.

57 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less by CCG, 2014/15 Comparison with demographically similar CCGs Below 140/85 Not below 140/85 Exceptions reported

NHS City and Hackney CCG 82.6%

NHS Newham CCG 77.8%

NHS Greenwich CCG 76.7%

NHS Waltham Forest CCG 75.8%

NHS Wandsworth CCG 75.4%

NHS Brent CCG 75.3%

NHS Southwark CCG 75.2%

NHS Lambeth CCG 74.6%

NHS Lewisham CCG 74.0%

NHS Haringey CCG 71.7%

NHS Hammersmith and Fulham CCG 70.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

58 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2014/15

Not below 140/85 Exceptions reported

MANOR HEALTH CENTRE (SANTAMARIA) G85010 25 SOUTH LAMBETH ROAD (DR KILNER) G85086 59 DR CURRAN AND PARTNERS G85708 52 HETHERINGTON GROUP PRACTICE G85045 68 HURLEY GROUP AT STREATHAM PLACE G85118 46 GRAFTON SQUARE SURGERY (DR ALA) G85674 17 • in total, including exceptions, there VASSALL MEDICAL CENTRE G85073 46 PAXTON GREEN PRACTICE (DR MILLER) G85039 96 are 1,451 people whose blood THE STREATHAM HILL GROUP PRACTICE G85662 41 LAMBETH WALK GROUP PRACTICE G85054 73 pressure is not <= 140 / 85 THE VALE SURGERY G85096 16 HERNE HILL GROUP PRACTICE G85016 29 • GP practice range: 9.4% to 39.7% HURLEY CLINIC G85053 66 CROWN DALE MEDICAL CENTRE G85022 50 MINET GREEN HEALTH PRACTICE (DR LAI) G85135 39 THE KNIGHTS HILL SURGERY G85047 18 CLAPHAM PARK GROUP PRACTICE G85109 59 HETHERINGTON AT THE PAVILLION (DR PATEL) Y03063 23 STREATHAM COMMON GROUP PRACTICE G85014 67 WATERLOO HEALTH CENTRE G85136 28 BROCKWELL PARK SURGERY G85137 13 BINFIELD ROAD SURGERY G85123 31 BRIXTON HILL GROUP PRACTICE G85025 36 SANDMERE ROAD PRACTICE G85083 35 SPRINGFIELD MEDICAL CENTRE G85673 19 THE TULSE HILL PRACTICE G85133 30 THE CORNER SURGERY G85127 13 CLAPHAM FAMILY PRACTICE G85011 38 STOCKWELL GROUP PRACTICE G85028 72 THE VAUXHALL SURGERY G85102 11 HERNE HILL ROAD MEDICAL PRACTICE G85690 17 DR WICKREMESINGHE SSG Y00020 20 THE EXCHANGE SURGERY G85647 18 STREATHAM HIGH PRACTICE G85002 16 BECKETT HOUSE PRACTICE G85100 12 THE ROSENDALE SURGERY (DR LEONARD) G85706 17 THE DEERBROOK SURGERY (DR WRIGHT) G85129 8 RIVERSIDE MEDICAL PRACTICE Y01962 7 EDITH CAVELL PRACTICE G85724 13 MAWBEY GROUP PRACTICE (LOGAN) G85130 18 AKERMAN MEDICAL PRACTICE G85695 10 PALACE ROAD SURGERY G85041 16 VALLEY ROAD SURGERY G85044 16 DR. MASTERTON'S SURGERY G85021 16 BRIXTON WATER LANE PRACTICE G85088 10 NORWOOD SURGERY (DR FERNANDES) G85113 10 MYATTS FIELD MEDICAL PRACTICE (DR WHITMEY) G85078 6 DR. GUNASUNTHARAM SURGERY G85682 5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

59 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2014/15 – opportunities compared to GP cluster

10% 5% 0% -5% -10% -15% -20% -25% -30%

MANOR HEALTH CENTRE (SANTAMARIA) 15

SOUTH LAMBETH ROAD (DR KILNER) 35

DR CURRAN AND PARTNERS 30 • using the GP cluster method of HETHERINGTON GROUP PRACTICE 38 calculating potential gains, if each HURLEY GROUP AT STREATHAM PLACE 25 practice was to achieve as well as the GRAFTON SQUARE SURGERY (DR ALA) 9 upper quartile of its national cluster, then an additional 518 people would VASSALL MEDICAL CENTRE 23 be treated THE STREATHAM HILL GROUP PRACTICE 20

LAMBETH WALK GROUP PRACTICE 34

THE VALE SURGERY 7

RIVERSIDE MEDICAL PRACTICE 1

EDITH CAVELL PRACTICE 1

MAWBEY GROUP PRACTICE (LOGAN) 1

AKERMAN MEDICAL PRACTICE

VALLEY ROAD SURGERY

PALACE ROAD SURGERY

NORWOOD SURGERY (DR FERNANDES)

BRIXTON WATER LANE PRACTICE

DR. MASTERTON'S SURGERY

DR. GUNASUNTHARAM SURGERY Details of this methodology are available on slide 9. Click here to view them.

60 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with CCGs in the STP Recorded Not recorded Exceptions reported

NHS Southwark CCG 77.2% • 5,701 people with CKD (diagnosed*) in NHS Lambeth CCG NHS Lambeth CCG 76.4% • 4,353 (76.4%) people who have a record of urine albumin:creatinine ratio test NHS Bexley CCG 76.0% • 312 (5.5%) people who are exceptions • 1,036 (18.2%) additional people who NHS Lewisham CCG 74.9% have no record of urine albumin:creatinine ratio test

NHS Greenwich CCG 70.6%

NHS Bromley CCG 69.5%

*Using the QOF clinical indicator CKD004 England 75.4% denominator plus exceptions. Note: as the CKD004 indicator was removed from the QOF in 15/16 this is historic data 0% 20% 40% 60% 80% 100% taken from the 2014/15 QOF.

61 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with demographically similar CCGs Recorded Not recorded Exceptions reported

NHS City and Hackney CCG 84.4%

NHS Southwark CCG 77.2%

NHS Wandsworth CCG 76.7%

NHS Lambeth CCG 76.4%

NHS Haringey CCG 76.0%

NHS Lewisham CCG 74.9%

NHS Waltham Forest CCG 74.7%

NHS Brent CCG 74.4%

NHS Newham CCG 74.2%

NHS Greenwich CCG 70.6%

NHS Hammersmith and Fulham CCG 69.6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

62 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes do not have a record of a urine albumin: creatinine ratio test in the preceding 12 months by GP practice, 2014/15

Not recorded Exceptions reported

THE VALE SURGERY G85096 27 THE DEERBROOK SURGERY (DR WRIGHT) G85129 21 HETHERINGTON GROUP PRACTICE G85045 75 DR. GUNASUNTHARAM SURGERY G85682 21 DR. MASTERTON'S SURGERY G85021 42 PAXTON GREEN PRACTICE (DR MILLER) G85039 102 • in total, including exceptions, there DR CURRAN AND PARTNERS G85708 46 PALACE ROAD SURGERY G85041 31 are 1,348 people who have no record MINET GREEN HEALTH PRACTICE (DR LAI) G85135 42 MYATTS FIELD MEDICAL PRACTICE (DR WHITMEY) G85078 13 of urine albumin:creatinine ratio test THE STREATHAM HILL GROUP PRACTICE G85662 38 BROCKWELL PARK SURGERY G85137 15 • GP practice range: 5.4% to 50.0% CLAPHAM FAMILY PRACTICE G85011 45 SANDMERE ROAD PRACTICE G85083 39 STREATHAM COMMON GROUP PRACTICE G85014 72 LAMBETH WALK GROUP PRACTICE G85054 64 HURLEY CLINIC G85053 59 CROWN DALE MEDICAL CENTRE G85022 43 HERNE HILL ROAD MEDICAL PRACTICE G85690 20 THE VAUXHALL SURGERY G85102 12 BINFIELD ROAD SURGERY G85123 31 VASSALL MEDICAL CENTRE G85073 35 HURLEY GROUP AT STREATHAM PLACE G85118 33 CLAPHAM PARK GROUP PRACTICE G85109 54 BRIXTON HILL GROUP PRACTICE G85025 34 DR WICKREMESINGHE SSG Y00020 22 EDITH CAVELL PRACTICE G85724 16 SPRINGFIELD MEDICAL CENTRE G85673 16 HETHERINGTON AT THE PAVILLION (DR PATEL) Y03063 18 GRAFTON SQUARE SURGERY (DR ALA) G85674 10 STOCKWELL GROUP PRACTICE G85028 58 RIVERSIDE MEDICAL PRACTICE Y01962 7 NORWOOD SURGERY (DR FERNANDES) G85113 13 MANOR HEALTH CENTRE (SANTAMARIA) G85010 11 THE ROSENDALE SURGERY (DR LEONARD) G85706 16 THE KNIGHTS HILL SURGERY G85047 11 SOUTH LAMBETH ROAD (DR KILNER) G85086 24 THE CORNER SURGERY G85127 9 HERNE HILL GROUP PRACTICE G85016 13 STREATHAM HIGH PRACTICE G85002 11 AKERMAN MEDICAL PRACTICE G85695 8 BRIXTON WATER LANE PRACTICE G85088 9 BECKETT HOUSE PRACTICE G85100 8 MAWBEY GROUP PRACTICE (LOGAN) G85130 12 THE TULSE HILL PRACTICE G85133 14 VALLEY ROAD SURGERY G85044 11 WATERLOO HEALTH CENTRE G85136 12 THE EXCHANGE SURGERY G85647 5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

63 CVD: Primary Care Intelligence Packs Heart

64 CVD: Primary Care Intelligence Packs Management of Heart Disease

Premature death and disability in people with What questions should we ask in our CCG? CHD can be reduced significantly by systematic 1. for each indicator how wide is the variation in evidence based management in primary care achievement and exception reporting? 2. how many people would benefit if all practices performed as well as the best? 3. how can we support practices who are Coronary Heart Disease is one of the principal causes of average and below average to perform as premature death and disability. The key elements of management for well as the best in: an individual who has already had a heart attack or angina are • more systematic delivery of evidence symptom control and secondary prevention of further cardiovascular based care for people with CHD events and premature mortality. There is robust evidence to support the • improved detection and management use of anti-platelet treatment, statins, beta-blockers and angiotensin of heart failure converting enzyme inhibitors or angiotensin receptor blockers. There is also robust evidence to support good control of blood pressure. Each of these interventions is incentivised in QOF but variation in achievement What might help and exception reporting at practice level shows that there is often 1. roll out of GRASP-Heart Failure audit tool considerable potential for improving management and outcomes. that identifies people with heart failure who are undiagnosed or under treated 2. education for health professionals to Heart failure is a common and an important complication of promote evidence based management of coronary heart disease and other conditions. Appropriate treatment CHD and high quality measurement of including up-titration of ace inhibitors and beta blockers in heart failure blood pressure due to LVSD can significantly improve symptom control and quality of 3. ensure access to rapid access diagnostic life, and improve outcomes for patients. Despite this, around a quarter clinics and specialist support for of people with heart failure are undetected and untreated. And amongst management of angina and heart failure those who are diagnosed, there is significant variation in the quality of 4. ensure access to cardiac rehab for care. individuals with CHD and heart failure

65 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with CCGs in the STP

NHS Bexley CCG 0.77%

• prevalence of 0.41% in NHS Lambeth NHS Bromley CCG 0.66% CCG compared to 0.76% in England

NHS Greenwich CCG 0.61%

NHS Lewisham CCG 0.47%

NHS Southwark CCG 0.46%

NHS Lambeth CCG 0.41%

England 0.76%

0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9%

66 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with demographically similar CCGs

NHS City and Hackney CCG 0.64%

NHS Greenwich CCG 0.61%

NHS Brent CCG 0.54%

NHS Newham CCG 0.54%

NHS Haringey CCG 0.50%

NHS Lewisham CCG 0.47%

NHS Waltham Forest CCG 0.46%

NHS Southwark CCG 0.46%

NHS Hammersmith and Fulham CCG 0.41%

NHS Lambeth CCG 0.41%

NHS Wandsworth CCG 0.32%

0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7%

67 CVD: Primary Care Intelligence Packs Heart failure prevalence by GP practice

GP practice CCG

STREATHAM PLACE SURGERY G85118 0.9% STREATHAM COMMON GROUP PRACTICE G85014 0.8% NORWOOD SURGERY G85113 0.8% DR. MASTERTON'S SURGERY G85021 0.7% THE STREATHAM HILL GROUP PRACTICE G85662 0.7% VASSALL MEDICAL CENTRE G85073 0.7% • 1,610 people with diagnosed heart WATER LANE SURGERY G85088 0.6% THE VALE SURGERY G85096 0.5% failure in NHS Lambeth CCG HETHERINGTON GROUP PRACTICE G85045 0.5% STOCKWELL GROUP PRACTICE G85028 0.5% • GP practice range: 0.0% to 0.9% MINET GREEN HEALTH PRACTICE G85135 0.5% THE TULSE HILL PRACTICE G85133 0.5% SANDMERE PRACTICE G85083 0.5% LAMBETH WALK GROUP PRACTICE G85054 0.5% THE CORNER SURGERY G85127 0.5% BECKETT HOUSE PRACTICE G85100 0.5% HURLEY CLINIC G85053 0.5% DR WICKREMESINGHE SSG Y00020 0.5% DR CURRAN & PARTNERS G85708 0.5% MAWBEY GROUP PRACTICE G85130 0.4% VALLEY ROAD SURGERY G85044 0.4% BINFIELD ROAD SURGERY G85123 0.4% BRIXTON HILL GROUP PRACTICE G85025 0.4% HETHERINGTON AT THE PAVILION Y03063 0.4% SPRINGFIELD MEDICAL CENTRE G85673 0.4% DR SHEILA SANTAMARIA G85010 0.4% CLAPHAM FAMILY PRACTICE G85011 0.4% PALACE ROAD SURGERY G85041 0.4% THE VAUXHALL SURGERY G85102 0.4% HERNE HILL GROUP PRACTICE G85016 0.4% HERNE HILL ROAD MEDICAL PRACTICE G85690 0.4% THE ROSENDALE SURGERY G85706 0.4% CROWN DALE MEDICAL CENTRE G85022 0.3% AKERMAN MEDICAL PRACTICE G85695 0.3% THE SOUTH LAMBETH RD PRACTICE G85086 0.3% CLAPHAM PARK GROUP PRACTICE G85109 0.3% PAXTON GREEN GROUP PRACTICE G85039 0.3% THE DEERBROOK SURGERY G85129 0.3% WATERLOO HEALTH CENTRE G85136 0.3% GRAFTON SQUARE SURGERY G85674 0.3% DR. GUNASUNTHARAM SURGERY G85682 0.3% KNIGHTS HILL SURGERY SUITE 1 G85047 0.2% THE EXCHANGE SURGERY G85647 0.2% STREATHAM HIGH PRACTICE G85002 0.2% EDITH CAVELL PRACTICE G85724 0.2% BROCKWELL PARK SURGERY G85137 0.2% RIVERSIDE MEDICAL PRACTICE Y01962 0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9% 1.0%

68 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with CCGs in the STP Treatment No treatment Exceptions reported

NHS Lewisham CCG 92.0% • 514 people with heart failure* with LVSD in NHS Lambeth CCG NHS Bromley CCG 90.7% • 445 (86.6%) people treated with ACE- I or ARB • 68 (13.2%) people who are NHS Greenwich CCG 89.4% exceptions • 1 (0.2%) additional people who are not treated with ACE-I or ARB NHS Bexley CCG 87.7%

NHS Southwark CCG 87.6%

NHS Lambeth CCG 86.6%

England 84.7%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF003 denominator plus exceptions

69 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported

NHS Lewisham CCG 92.0%

NHS Greenwich CCG 89.4%

NHS Waltham Forest CCG 88.7%

NHS Brent CCG 88.4%

NHS Southwark CCG 87.6%

NHS City and Hackney CCG 86.7%

NHS Lambeth CCG 86.6%

NHS Wandsworth CCG 86.3%

NHS Hammersmith and Fulham CCG 84.8%

NHS Newham CCG 84.3%

NHS Haringey CCG 83.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

70 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB by GP practice

No treatment Exceptions reported

THE DEERBROOK SURGERY G85129 1 GRAFTON SQUARE SURGERY G85674 2 BECKETT HOUSE PRACTICE G85100 2 BINFIELD ROAD SURGERY G85123 2 SPRINGFIELD MEDICAL CENTRE G85673 2 KNIGHTS HILL SURGERY SUITE 1 G85047 1 • in total, including exceptions, there DR CURRAN & PARTNERS G85708 2 NORWOOD SURGERY G85113 3 are 69 people who are not treated PAXTON GREEN GROUP PRACTICE G85039 2 HERNE HILL GROUP PRACTICE G85016 4 with ACE-I or ARB DR. MASTERTON'S SURGERY G85021 4 STREATHAM HIGH PRACTICE G85002 2 • GP practice range: 0.0% to 33.3% STOCKWELL GROUP PRACTICE G85028 7 THE SOUTH LAMBETH RD PRACTICE G85086 3 BRIXTON HILL GROUP PRACTICE G85025 4 MAWBEY GROUP PRACTICE G85130 4 HURLEY CLINIC G85053 2 CROWN DALE MEDICAL CENTRE G85022 2 THE CORNER SURGERY G85127 3 THE ROSENDALE SURGERY G85706 1 WATERLOO HEALTH CENTRE G85136 1 CLAPHAM PARK GROUP PRACTICE G85109 3 THE TULSE HILL PRACTICE G85133 1 MINET GREEN HEALTH PRACTICE G85135 3 WATER LANE SURGERY G85088 1 THE STREATHAM HILL GROUP PRACTICE G85662 1 BROCKWELL PARK SURGERY G85137 1 HERNE HILL ROAD MEDICAL PRACTICE G85690 1 VALLEY ROAD SURGERY G85044 1 STREATHAM COMMON GROUP PRACTICE G85014 3 DR SHEILA SANTAMARIA G85010 CLAPHAM FAMILY PRACTICE G85011 PALACE ROAD SURGERY G85041 HETHERINGTON GROUP PRACTICE G85045 LAMBETH WALK GROUP PRACTICE G85054 VASSALL MEDICAL CENTRE G85073 SANDMERE PRACTICE G85083 THE VALE SURGERY G85096 THE VAUXHALL SURGERY G85102 STREATHAM PLACE SURGERY G85118 THE EXCHANGE SURGERY G85647 DR. GUNASUNTHARAM SURGERY G85682 AKERMAN MEDICAL PRACTICE G85695 EDITH CAVELL PRACTICE G85724 DR WICKREMESINGHE SSG Y00020 RIVERSIDE MEDICAL PRACTICE Y01962 HETHERINGTON AT THE PAVILION Y03063 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

71 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with CCGs in the STP Treatment No treatment Exceptions reported

NHS Lewisham CCG 88.8% • 445 people with heart failure* with LVSD treated with ACE-I/ARB in NHS NHS Southwark CCG 88.7% Lambeth CCG • 385 (86.5%) people treated with ACE- I/ARB and BB NHS Bromley CCG 87.9% • 42 (9.4%) people who are exceptions • 18 (4%) additional people who are not treated with ACE-I/ARB and BB NHS Lambeth CCG 86.5%

NHS Greenwich CCG 82.0%

NHS Bexley CCG 81.3%

England 77.7%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF004 denominator plus exceptions

72 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported

NHS Lewisham CCG 88.8%

NHS Southwark CCG 88.7%

NHS Lambeth CCG 86.5%

NHS Brent CCG 82.5%

NHS Wandsworth CCG 82.2%

NHS Greenwich CCG 82.0%

NHS Haringey CCG 81.4%

NHS City and Hackney CCG 77.8%

NHS Waltham Forest CCG 74.5%

NHS Hammersmith and Fulham CCG 74.0%

NHS Newham CCG 73.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

73 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB and BB by GP practice

No treatment Exceptions reported

BECKETT HOUSE PRACTICE G85100 3 THE VALE SURGERY G85096 1 HURLEY CLINIC G85053 4 VASSALL MEDICAL CENTRE G85073 4 HERNE HILL GROUP PRACTICE G85016 4 LAMBETH WALK GROUP PRACTICE G85054 1 • in total, including exceptions, there WATER LANE SURGERY G85088 2 STREATHAM PLACE SURGERY G85118 1 are 60 people who are not treated EDITH CAVELL PRACTICE G85724 1 CROWN DALE MEDICAL CENTRE G85022 2 with ACE-I or ARB BINFIELD ROAD SURGERY G85123 1 SPRINGFIELD MEDICAL CENTRE G85673 1 • GP practice range: 0.0% to 60.0% BRIXTON HILL GROUP PRACTICE G85025 3 VALLEY ROAD SURGERY G85044 2 WATERLOO HEALTH CENTRE G85136 1 DR WICKREMESINGHE SSG Y00020 2 SANDMERE PRACTICE G85083 2 STREATHAM COMMON GROUP PRACTICE G85014 7 STOCKWELL GROUP PRACTICE G85028 4 PAXTON GREEN GROUP PRACTICE G85039 1 THE TULSE HILL PRACTICE G85133 1 DR. MASTERTON'S SURGERY G85021 2 THE CORNER SURGERY G85127 2 HETHERINGTON AT THE PAVILION Y03063 1 MAWBEY GROUP PRACTICE G85130 2 THE STREATHAM HILL GROUP PRACTICE G85662 1 CLAPHAM PARK GROUP PRACTICE G85109 2 HERNE HILL ROAD MEDICAL PRACTICE G85690 1 THE SOUTH LAMBETH RD PRACTICE G85086 1 STREATHAM HIGH PRACTICE G85002 DR SHEILA SANTAMARIA G85010 CLAPHAM FAMILY PRACTICE G85011 PALACE ROAD SURGERY G85041 HETHERINGTON GROUP PRACTICE G85045 KNIGHTS HILL SURGERY SUITE 1 G85047 THE VAUXHALL SURGERY G85102 NORWOOD SURGERY G85113 THE DEERBROOK SURGERY G85129 MINET GREEN HEALTH PRACTICE G85135 BROCKWELL PARK SURGERY G85137 THE EXCHANGE SURGERY G85647 GRAFTON SQUARE SURGERY G85674 DR. GUNASUNTHARAM SURGERY G85682 AKERMAN MEDICAL PRACTICE G85695 THE ROSENDALE SURGERY G85706 DR CURRAN & PARTNERS G85708 RIVERSIDE MEDICAL PRACTICE Y01962 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

74 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP Below 150/90 Not below 150/90 Exceptions reported

NHS Southwark CCG 90.7% • 4,981 people with coronary heart disease* in NHS Lambeth CCG NHS Bexley CCG 90.0% • 4,433 (89%) people whose blood pressure <= 150 / 90 • 149 (3%) people who are exceptions NHS Lambeth CCG 89.0% • 399 (8%) additional people whose blood pressure is not <= 150 / 90

NHS Bromley CCG 87.4%

NHS Greenwich CCG 86.8%

NHS Lewisham CCG 86.2%

England 88.2%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD002 denominator plus exceptions

75 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported

NHS City and Hackney CCG 95.2%

NHS Southwark CCG 90.7%

NHS Newham CCG 90.1%

NHS Brent CCG 89.8%

NHS Wandsworth CCG 89.0%

NHS Lambeth CCG 89.0%

NHS Waltham Forest CCG 88.9%

NHS Greenwich CCG 86.8%

NHS Lewisham CCG 86.2%

NHS Haringey CCG 85.7%

NHS Hammersmith and Fulham CCG 83.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

76 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice

Not below 150/90 Exceptions reported

THE SOUTH LAMBETH RD PRACTICE G85086 26 LAMBETH WALK GROUP PRACTICE G85054 31 PAXTON GREEN GROUP PRACTICE G85039 60 HERNE HILL ROAD MEDICAL PRACTICE G85690 10 DR. GUNASUNTHARAM SURGERY G85682 8 THE STREATHAM HILL GROUP PRACTICE G85662 26 • in total, including exceptions, there CLAPHAM PARK GROUP PRACTICE G85109 30 CROWN DALE MEDICAL CENTRE G85022 29 are 548 people whose blood pressure THE VAUXHALL SURGERY G85102 9 BRIXTON HILL GROUP PRACTICE G85025 16 is not <= 150 / 90 VASSALL MEDICAL CENTRE G85073 14 HURLEY CLINIC G85053 23 • GP practice range: 2.3% to 25.2% WATERLOO HEALTH CENTRE G85136 14 CLAPHAM FAMILY PRACTICE G85011 19 DR. MASTERTON'S SURGERY G85021 17 NORWOOD SURGERY G85113 7 GRAFTON SQUARE SURGERY G85674 4 DR CURRAN & PARTNERS G85708 11 THE DEERBROOK SURGERY G85129 7 BECKETT HOUSE PRACTICE G85100 7 SANDMERE PRACTICE G85083 17 HETHERINGTON GROUP PRACTICE G85045 10 DR WICKREMESINGHE SSG Y00020 10 STOCKWELL GROUP PRACTICE G85028 18 WATER LANE SURGERY G85088 8 KNIGHTS HILL SURGERY SUITE 1 G85047 6 RIVERSIDE MEDICAL PRACTICE Y01962 4 THE CORNER SURGERY G85127 5 EDITH CAVELL PRACTICE G85724 7 HERNE HILL GROUP PRACTICE G85016 12 HETHERINGTON AT THE PAVILION Y03063 5 THE VALE SURGERY G85096 5 THE EXCHANGE SURGERY G85647 5 PALACE ROAD SURGERY G85041 7 BINFIELD ROAD SURGERY G85123 6 SPRINGFIELD MEDICAL CENTRE G85673 5 THE ROSENDALE SURGERY G85706 5 STREATHAM COMMON GROUP PRACTICE G85014 13 BROCKWELL PARK SURGERY G85137 4 MINET GREEN HEALTH PRACTICE G85135 8 STREATHAM PLACE SURGERY G85118 4 STREATHAM HIGH PRACTICE G85002 4 THE TULSE HILL PRACTICE G85133 4 AKERMAN MEDICAL PRACTICE G85695 2 VALLEY ROAD SURGERY G85044 2 DR SHEILA SANTAMARIA G85010 1 MAWBEY GROUP PRACTICE G85130 3 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

77 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice – opportunities compared to GP cluster

10% 5% 0% -5% -10% -15% -20% -25%

THE SOUTH LAMBETH RD PRACTICE 20

LAMBETH WALK GROUP PRACTICE 21

PAXTON GREEN GROUP PRACTICE 33 • using the GP cluster method of HERNE HILL ROAD MEDICAL PRACTICE 6 calculating potential gains, if each DR. GUNASUNTHARAM SURGERY 5 practice was to achieve as well as the THE STREATHAM HILL GROUP PRACTICE 16 upper quartile of its national cluster, then an additional 242 people would CLAPHAM PARK GROUP PRACTICE 18 be treated THE VAUXHALL SURGERY 5

BRIXTON HILL GROUP PRACTICE 9

VASSALL MEDICAL CENTRE 8

BROCKWELL PARK SURGERY

MINET GREEN HEALTH PRACTICE

STREATHAM PLACE SURGERY

STREATHAM HIGH PRACTICE

STREATHAM COMMON GROUP PRACTICE

AKERMAN MEDICAL PRACTICE

THE TULSE HILL PRACTICE

VALLEY ROAD SURGERY

DR SHEILA SANTAMARIA

MAWBEY GROUP PRACTICE Details of this methodology are available on slide 9. Click here to view them.

78 CVD: Primary Care Intelligence Packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with CCGs in the STP Optimal management No treatment Exceptions reported

NHS Bromley CCG 93.0% • 4,981 people with coronary heart disease* in NHS Lambeth CCG NHS Southwark CCG 92.6% • 4,523 (90.8%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant NHS Bexley CCG 92.2% • 214 (4.3%) people who are exceptions • 244 (4.9%) additional people who are NHS Lewisham CCG 91.9% not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant

NHS Greenwich CCG 91.4%

NHS Lambeth CCG 90.8%

England 91.8%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD005 denominator plus exceptions

79 CVD: Primary Care Intelligence Packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported

NHS Brent CCG 93.3%

NHS Newham CCG 93.3%

NHS Wandsworth CCG 93.0%

NHS City and Hackney CCG 92.9%

NHS Southwark CCG 92.6%

NHS Waltham Forest CCG 92.0%

NHS Lewisham CCG 91.9%

NHS Greenwich CCG 91.4%

NHS Haringey CCG 91.4%

NHS Lambeth CCG 90.8%

NHS Hammersmith and Fulham CCG 87.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

80 CVD: Primary Care Intelligence Packs Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice

No treatment Exceptions reported

CLAPHAM FAMILY PRACTICE G85011 34 PAXTON GREEN GROUP PRACTICE G85039 56 DR WICKREMESINGHE SSG Y00020 16 HERNE HILL GROUP PRACTICE G85016 23 NORWOOD SURGERY G85113 8 WATERLOO HEALTH CENTRE G85136 14 • in total, including exceptions, there THE SOUTH LAMBETH RD PRACTICE G85086 13 BRIXTON HILL GROUP PRACTICE G85025 13 are 458 people are not taking aspirin, RIVERSIDE MEDICAL PRACTICE Y01962 5 DR. MASTERTON'S SURGERY G85021 15 an alternative anti-platelet therapy, or CROWN DALE MEDICAL CENTRE G85022 21 STOCKWELL GROUP PRACTICE G85028 20 an anti-coagulant THE STREATHAM HILL GROUP PRACTICE G85662 17 STREATHAM PLACE SURGERY G85118 7 • GP practice range: 1.5% to 21.7% LAMBETH WALK GROUP PRACTICE G85054 14 VASSALL MEDICAL CENTRE G85073 9 HURLEY CLINIC G85053 15 DR CURRAN & PARTNERS G85708 8 CLAPHAM PARK GROUP PRACTICE G85109 17 HERNE HILL ROAD MEDICAL PRACTICE G85690 5 DR. GUNASUNTHARAM SURGERY G85682 4 EDITH CAVELL PRACTICE G85724 7 WATER LANE SURGERY G85088 7 THE VAUXHALL SURGERY G85102 5 HETHERINGTON GROUP PRACTICE G85045 8 THE TULSE HILL PRACTICE G85133 7 DR SHEILA SANTAMARIA G85010 3 BINFIELD ROAD SURGERY G85123 6 THE CORNER SURGERY G85127 4 THE ROSENDALE SURGERY G85706 5 MINET GREEN HEALTH PRACTICE G85135 10 THE DEERBROOK SURGERY G85129 4 BECKETT HOUSE PRACTICE G85100 4 VALLEY ROAD SURGERY G85044 5 STREATHAM COMMON GROUP PRACTICE G85014 12 GRAFTON SQUARE SURGERY G85674 2 BROCKWELL PARK SURGERY G85137 4 SPRINGFIELD MEDICAL CENTRE G85673 4 SANDMERE PRACTICE G85083 7 PALACE ROAD SURGERY G85041 4 MAWBEY GROUP PRACTICE G85130 5 STREATHAM HIGH PRACTICE G85002 3 HETHERINGTON AT THE PAVILION Y03063 2 THE VALE SURGERY G85096 2 KNIGHTS HILL SURGERY SUITE 1 G85047 2 AKERMAN MEDICAL PRACTICE G85695 1 THE EXCHANGE SURGERY G85647 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

81 CVD: Primary Care Intelligence Packs Some data on outcomes for people with cardiovascular disease

82 CVD: Primary Care Intelligence Packs Hospital admissions for coronary heart disease for all ages 2002/03 – 2015/16

NHS Lambeth CCG England 800

700 • in NHS Lambeth CCG, the hospital admission rate for coronary heart disease in 2015/16 was 412.8 (675) 600 compared to 527.9 for England

500

400

300

Age Age standardised (per rate 100,000) 200

100

0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved

83 CVD: Primary Care Intelligence Packs Hospital admissions for stroke for all ages 2002/03 – 2015/16

NHS Lambeth CCG England 350

• in NHS Lambeth CCG, the hospital 300 admission rate for stroke in 2015/16 was 262.6 (414) compared to 172.8 for England 250

200

150

100 Age standardised standardised Age (per rate 100,000)

50

0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved

84 CVD: Primary Care Intelligence Packs Additional risk of complications for people with diabetes, three year follow up, 2013/14

NHS Lambeth CCG England

89.2% Angina 136.8% • The risk of a stroke was 67.8% higher and the risk of a heart attack was 90.4% 90.4% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 455.5% higher. 123.0% Heart failure 150.0%

67.8% Stroke 81.3%

455.5% Major amputation 445.8%

457.7% Minor amputation 753.5%

134.7% RRT 293.0%

0% 100% 200% 300% 400% 500% 600% 700% 800% Note: This slide uses data from the National Diabetes Audit (NDA)

85 CVD: Primary Care Intelligence Packs Deaths from coronary heart disease, under 75s

NHS Lambeth CCG England 100

90 • in NHS Lambeth CCG, the early mortality rate for coronary heart 80 disease in 2013-15 was 43.7, compared to 40.6 for England 70

60

50

40

30 Age Age standardised (per rate 1000,000) 20

10

0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Source: Office for National Statistics (ONS) mortality data 2002 - 2015

86 CVD: Primary Care Intelligence Packs Deaths from stroke, under 75s

NHS Lambeth CCG England 45

40 • in NHS Lambeth CCG, the early mortality rate for stroke in 2013-15 35 was 18.8, compared to 13.6 for England

30

25

20

15 Age Age standardised (per rate 100,000) 10

5

0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Source: Office for National Statistics (ONS) mortality data 2002 - 2015

87 CVD: Primary Care Intelligence Packs Appendix Data sources

• Quality and Outcomes Framework (QOF), 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved

• Non-diabetic hyperglycaemia prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/nhs-diabetes- prevention-programme-non-diabetic-hyperglycaemia

• Diabetes prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/diabetes-prevalence-estimates-for- local-populations

• CKD Prevalence model, G.Aitken, University of Southampton , 2014 https://www.gov.uk/government/publications/ckd- prevalence-estimates-for-local-and-regional-populations

• Hypertension prevalence estimates for local CCG populations. Created using data from: QOF hypertension registers 2014/15 and; Undiagnosed hypertension estimates for adults 16 years and older. 2014. Department of Primary Care & Public Health, Imperial College London https://www.gov.uk/government/publications/hypertension-prevalence-estimates-for-local-populations

• NHS Stop smoking services Copyright © 2014, NHS Digital

• Norberg J, Bäckström S , Jansson J-H, Johansson L. Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clin Epidemiol 2013 ; 5 475 – 81.

• National Diabetes Audit, 2013/14 and 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved

• Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved

• Office for National Statistics (ONS) mortality data 2002 – 2015, Copyright © 2017, Re-used with the permission of the Office for National Statistics. All rights reserved

88 CVD: Primary Care Intelligence Packs About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health, and are a distinct delivery organisation with operational autonomy to advise and support government, local authorities and the NHS in a professionally independent manner.

Public Health England Wellington House 133-155 Waterloo Road London SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland

© Crown copyright 2017 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

Published June 2017 Gateway number 2017095

89